Standard I: Terminology

Abstract

Consistent terminology provides guidance and clear communication and reflects shared values in simulation experiences, research, and publications. Standardized terminology enhances understanding and communication among planners, participants, and others involved in simulation experiences. It also promotes consistency in the development, implementation, evaluation, and publication of or about simulated clinical experiences or research studies for use in education and practice. Terminology is descriptive and consistent in a variety of settings, written documents, and publications. Use of standard terminology facilitates consistent experiences for participants, regardless of the simulation environment. The criterion for this Standard is to include definitions for all terms used in the Standards of Best Practice in Patient Simulation. Andragogy: Expands on pedagogy and refers to active, learner-focused education for people of all ages. It is based on learning principles that involve problem solving that is relevant to the learner’s everyday experiences. Clinical Judgment: The art of making a series of decisions in situations, based on various types of knowledge, in a way that allows the individual to recognize salient aspects of or changes in a clinical situation, interpret their meaning, respond appropriately, and reflect on the effectiveness of the intervention. Clinical judgment is influenced by the individual’s overall experiences that have helped to develop problem-solving, critical-thinking, and clinical-reasoning abilities (del Bueno, 1994del Bueno D.J. Why can’t new grads think like nurses?.Nurse Educ. 1994; 19: 9-11Crossref PubMed Scopus (37) Google Scholar, Dillard et al., 2009Dillard N. Sideras S. Carlton K.H. Lasater K. Siktberg L. A collaborative project to apply and evaluate the clinical judgment model through simulation.Nursing Education Research. 2009; 30: 99-104Google Scholar, Jackson et al., 2004Jackson M. Ignatavicius D.D. Case B. Conversations in critical thinking and clinical judgment. Pohl, Pensacola, FL2004Google Scholar, Lasater, 2007Lasater K. Clinical judgment development: Using simulation to create an assessment rubric.Journal of Nursing Education. 2007; 46: 496-503PubMed Google Scholar, Tanner, 2006Tanner C.A. Thinking like a nurse: A research-based model of clinical judgment in nursing.Journal of Nursing Education. 2006; 45: 204-211PubMed Google Scholar). See Figure 1. Clinical Reasoning: The ability to gather and comprehend data while recalling knowledge, skills (technical and nontechnical), and attitudes about a situation as it unfolds. After analysis, information is put together into a meaningful whole when applying the information to new situations (Alfaro-LeFever, 1995Alfaro-LeFever R. Critical thinking in nursing: A practical approach. W. B. Saunders, Philadelphia1995Google Scholar, Benner et al., 2010Benner P. Sutphen M. Leonard V. Day L. Educating nurses: A call for radical transformation. Jossey-Bass, San Francisco2010Google Scholar). Clinical Scenario: The plan of an expected and potential course of events for a simulated clinical experience. The clinical scenario provides the context for the simulation and can vary in length and complexity, depending on the objectives. Designing the clinical scenario should include the following:•Participant preparation.•Prebriefing: objectives, questions, and/or material.•Patient information describing the situation to be managed.•Student learning objectives.•Environmental conditions, including manikin or standardized patient preparation.•Related equipment, props, and tools and/or resources for assessing and managing the simulated experience to increase the realism.•Roles, expectations, and/or limitations of each role to be played by participants.•A progression outline including a beginning and an ending.•Debriefing process.•Evaluation criteria (Jeffries, 2007Jeffries P.R. Simulation in nursing education: From conceptualization to evaluation. National League for Nursing, New York2007Google Scholar). Coaching: A method of directing or instructing a person or group of people in order to achieve a goal or goals, develop a specific skill or skills, or develop a competency or competencies. Competence: Standardized requirement for an individual to properly perform a specific role. It encompasses a combination of discrete and measureable knowledge, skills, and attitudes that are essential for patient safety and quality patient care (National League for Nursing, 2010National League for Nursing Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate, and research doctorate programs in nursing. National League for Nursing, New York2010Google Scholar). Computer-Assisted Instruction: A teaching process that uses a computer in the presentation of instructional materials. The participant may be asked a question or presented with a problem. The participant inputs a response and receives feedback (sometimes immediate) about the answer. This process is used to teach, provide feedback, and evaluate clinical judgment and critical thinking. Confederate: A term sometimes used to describe an embedded actor (see Embedded Actor). Confidence: Belief in oneself and one’s abilities. Confidence Interval: Margin of error. Confidence Level: A percentage that represents how certain one can be that a test measures what it intends to. Critical Thinking: A disciplined process that requires validation of data, including any assumptions that may influence thoughts and actions; and then careful reflection on the entire process while evaluating the effectiveness of what has been determined as the necessary action(s) to take. This process entails purposeful, goal-directed thinking and is based on scientific principles and methods (evidence) rather than assumptions and/or conjecture (Alfaro-LeFever, 1995Alfaro-LeFever R. Critical thinking in nursing: A practical approach. W. B. Saunders, Philadelphia1995Google Scholar, Benner, 2004Benner P. Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education.Bulletin of Science, Technology & Society. 2004; 24: 188-199https://doi.org/10.1177/0270467604265061Crossref Scopus (265) Google Scholar, Jackson et al., 2004Jackson M. Ignatavicius D.D. Case B. Conversations in critical thinking and clinical judgment. Pohl, Pensacola, FL2004Google Scholar). Cuing: Information provided that helps the participant progress through the clinical scenario to achieve stated objectives (National League for Nursing Simulation Innovation Resource Center, 2010National League for Nursing Simulation Innovation Resource Center (NLN-SIRC). (2010). SIRC glossary. Retrieved June 15, 2011 from http://sirc.nln.org/mod/glossary/view.php?id=183Google Scholar). Debriefing: An activity that follows a simulation experience and that is led by a facilitator. Participant reflective thinking is encouraged, and feedback is provided regarding the participants’ performance while various aspects of the completed simulation are discussed. Participants are encouraged to explore emotions, question, reflect, and provide feedback to each other. The purpose of debriefing is to move toward assimilation and accommodation in order to transfer learning to future situations (Johnson-Russell and Bailey, 2010Johnson-Russell J. Bailey C. Facilitated debriefing.in: Nehring W.M. Lashley F.R. High-fidelity patient simulation in nursing education. Jones and Bartlett, Boston2010: 369-385Google Scholar, National League for Nursing Simulation Innovation Resource Center, 2010National League for Nursing Simulation Innovation Resource Center (NLN-SIRC). (2010). SIRC glossary. Retrieved June 15, 2011 from http://sirc.nln.org/mod/glossary/view.php?id=183Google Scholar). Decision-Making Abilities: An outcome of mental processes (cognitive process) leading to the selection of a course of action from among several alternatives. Embedded Actor (also known as Scenario Guide, Scenario Role Player, or Confederate): A person assigned a role in a simulation encounter to help guide the scenario. The guidance may be influential as positive, negative, or neutral or as a distracter, depending on the objective(s), the level of the participants and of the scenario. Although the embedded actor’s role is part of the situation, the underlying purpose of the embedded actor is not identified to the participants in the scenario or simulation. Evaluation or Assessment: Formative Assessment: Assessment wherein the facilitator’s focus is on the participant’s progress toward goal attainment; a process for an individual or group engaged in a simulation activity for the purpose of providing constructive feedback for that individual or group to improve (Billings and Halstead, 2009Billings D.M. Halstead J.A. Teaching in nursing: A guide for faculty. Elsevier, New York2009Google Scholar, National League for Nursing Simulation Innovation Resource Center, 2010National League for Nursing Simulation Innovation Resource Center (NLN-SIRC). (2010). SIRC glossary. Retrieved June 15, 2011 from http://sirc.nln.org/mod/glossary/view.php?id=183Google Scholar). Summative Evaluation: Evaluation at the end of a learning period, in which participants are provided with feedback about their achievement of outcome criteria; a process for determining the competence of a participant engaged in health care activity. The assessment of achievement of outcome criteria may be associated with an assigned grade (Billings and Halstead, 2009Billings D.M. Halstead J.A. Teaching in nursing: A guide for faculty. Elsevier, New York2009Google Scholar, National League for Nursing Simulation Innovation Resource Center, 2010National League for Nursing Simulation Innovation Resource Center (NLN-SIRC). (2010). SIRC glossary. Retrieved June 15, 2011 from http://sirc.nln.org/mod/glossary/view.php?id=183Google Scholar). Facilitation Methods: Facilitator Prompting Simulation: Simulation can be led with prompting and guidance by the facilitator, keeping the participant(s) focused by means of guidance and instruction throughout the decision-making process. Prompting is provided in an effort to assist the participant(s) in prioritization of assessment, data collection, implementation, and evaluation. This guidance allows the participant(s) to progress toward completion of objectives (Nehring and Lashley, 2010Nehring W.M. Lashley F.R. High-fidelity patient simulation in nursing education. Jones and Bartlett, Boston2010Google Scholar). Partial Facilitator Prompting Simulation: During the simulation experience, participants carry out activities without interruption. At the beginning, they enter the room with a plan and execute the plan without interruption. This approach gives the participants time to carry out the intended plan and offers them the opportunity for self-correction. Group decisions and discussions are employed. If participants venture off track, the simulated experience is taken in a new direction. Redirection can be introduced in the form of verbal cues by the “patient,” incoming lab results, health care provider phone calls, or input from the facilitator (Nehring and Lashley, 2010Nehring W.M. Lashley F.R. High-fidelity patient simulation in nursing education. Jones and Bartlett, Boston2010Google Scholar). No Facilitator Prompting Simulation: Participants provide care without any interruptions and continue the simulation until the scenario is completed. Cuing may be provided if needed to assist in redirecting the scenario. At the completion of the scenario, the facilitator engages the participants in the debriefing session (Nehring and Lashley, 2010Nehring W.M. Lashley F.R. High-fidelity patient simulation in nursing education. Jones and Bartlett, Boston2010Google Scholar). Facilitator: An individual who guides and supports participants toward understanding and achieving objectives. Feedback: One-way communication given to a participant from a facilitator, simulator, or other participants in an effort to improve performance. Fidelity: Believability, or the degree to which a simulated experience approaches reality; as fidelity increases, realism increases. The level of fidelity is determined by the environment, the tools and resources used, and many factors associated with the participants. Fidelity can involve a variety of dimensions, including (a) physical factors such as environment, equipment, and related tools; (b) psychological factors such as emotions, beliefs, and self-awareness of participants; (c) social factors such as participant and instructor motivation and goals; (d) culture of the group; and (e) degree of openness and trust, as well as participants’ modes of thinking (Dieckmann et al., 2007Dieckmann P. Gaba D. Rall M. Deepening the theoretical foundations of patient simulation as social practice.Simulation in Healthcare. 2007; 2: 183-193Crossref PubMed Scopus (269) Google Scholar, National League for Nursing Simulation Innovation Resource Center, 2010National League for Nursing Simulation Innovation Resource Center (NLN-SIRC). (2010). SIRC glossary. Retrieved June 15, 2011 from http://sirc.nln.org/mod/glossary/view.php?id=183Google Scholar). Guided Reflection: Process used by the facilitator during debriefing that reinforces the critical aspects of the experience and encourages insightful learning, allowing the participant to assimilate theory, practice, and research in order to influence future actions (National League for Nursing Simulation Innovation Resource Center, 2010National League for Nursing Simulation Innovation Resource Center (NLN-SIRC). (2010). SIRC glossary. Retrieved June 15, 2011 from http://sirc.nln.org/mod/glossary/view.php?id=183Google Scholar). Guidelines: Procedures or principles that are not mandatory but are used to assist in meeting standards. Guidelines are not necessarily comprehensive; they provide a framework for developing policies and procedures. High-Stakes Evaluation: An evaluation process associated with a simulation activity and that has a major consequence or is the basis for a major grading decision, including pass–fail implications. High stakes refers to the outcome or consequences of the process. Knowledge: The awareness, understanding, and expertise an individual acquires through experience or education. Outcome: Results of the participants’ progress toward meeting learning objectives. Participant Objectives: Statement of cognitive (knowledge), affective (attitude), and/or psychomotor (skills) goal(s). Pedagogy: The art or science of instructional methods. The study of teaching methods, including goals of education and the ways those goals can be achieved. Prebriefing: An information session held prior to the start of a simulation activity and in which instructions or preparatory information is given to participants. The purpose of the prebriefing is to set the stage for a scenario and assist participants in achieving scenario objectives. Suggested activities in a prebriefing include an orientation to the equipment, environment, manikin, roles, time allotment, objectives, and patient situation. Problem Solving: The skill used in managing the work role, working in a team, and managing a health care setting. Problem solving refers to the process of selectively attending to information in the patient care setting, using existing knowledge and collecting pertinent data to formulate a solution. This complex process requires different cognitive processes, including methods of reasoning and strategizing, in order to manage a situation (Uys et al., 2004Uys L.R. Van Rhyn L.L. Gwele N.S. McInerney P. Tanga T. Problem-solving competency of nursing graduates.Journal of Advanced Nursing. 2004; 48: 500-509Crossref PubMed Scopus (29) Google Scholar). Prompt: A cue given to a participant in a scenario. Psychomotor Skill: The ability to carry out physical movements efficiently and effectively, with speed and accuracy. Psychomotor skill is more than the ability to perform; it includes the ability to perform proficiently, smoothly, and consistently under varying conditions and within appropriate time limits. Questioning: The strategic process of seeking information or knowledge, thoughts, feelings, and judgments of the participant(s) before, during, and after a scenario. Reflective Thinking: The engagement of self-monitoring that occurs during or after a simulation experience. Considered an essential component of experiential learning, it promotes the discovery of new knowledge with the intent of applying this knowledge to future situations. Reflective thinking is necessary for metacognitive skill acquisition and clinical judgment and has the potential to decrease the gap between theory and practice. Reflection requires the creativity and conscious self-evaluation to deal with unique patient situations (Decker, 2007Decker S. Integrating guided reflection into simulated learning experiences.in: Jeffries P. Rizzolo M.A. Using simulations in healthcare: The core essentials in getting started. National League for Nursing, New York2007Google Scholar, Decker, 2007Decker S. Simulation as an educational strategy. Unpublished dissertation. Texas Woman’s University, Denton, TX2007Google Scholar; Dewey, 1933Dewey J. How we think: A restatement of the relation of reflective thinking to the educative process. D. C. Heath, Boston1933Google Scholar, Kolb, 1984Kolb D.A. Experiential learning: Experience as the source of learning and development. Prentice Hall, Englewood Cliffs, NJ1984Google Scholar, Kuiper and Pesut, 2004Kuiper R.A. Pesut D.J. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: Self-regulated learning theory.Journal of Advanced Nursing. 2004; 45: 381-391Crossref PubMed Scopus (188) Google Scholar, Ruth-Sahd, 2003Ruth-Sahd L.A. Reflective practice: A critical analysis of data-based studies and implications for nursing education.Journal of Nursing Education. 2003; 42: 488-497PubMed Google Scholar, Schön, 1983Schön D.A. The reflective practitioner: How professionals think in action. Harper Collins, New York1983Google Scholar, Schön, 1987Schön D.A. Educating the reflective practitioner. Jossey Bass, Hoboken, NJ1987Google Scholar). Reliability: The consistency of a measurement, or the degree to which an instrument measures in the same way each time it is used under the same conditions with the same participants. It is the repeatability of a measurement. A measurement is considered reliable if a person’s scores on the same test given twice are similar. Reliability can be determined by a test–retest method or by testing for internal consistency. Role: A character assumed in a scenario or simulation. Safe Learning Environment: The emotional climate that facilitators create by the interaction between facilitators and participants. In this positive emotional climate, participants feel at ease taking risks, making mistakes, or extending themselves beyond their comfort zone. Facilitators are thoroughly aware of the psychological aspects of learning, aware of the effects of unintentional bias, aware of cultural differences, and attentive to their own state of mind in order to effectively create a safe environment for learning (Readingtoparents, 2005Readingtoparents.org. (2005). A Safe Learning Environment. Retrieved May 30, 2011, from http://www.rationalamerican.com/rp.org/archives/safe.htmlGoogle Scholar). Safe Patient Care: Quality care provided by health care practitioners with a focus on the prevention of harm to patients. Scenario: See Clinical Scenario. Simulated Clinical Experience: The simulated clinical experience includes prebriefing, the clinical scenario, and debriefing. It is the engagement part of a clinical scenario. Simulation: A pedagogy using one or more typologies to promote, improve and/or validate a participant’s progression from novice to expert (Benner, 1984Benner P. From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley, Boston, MA1984Google Scholar, Decker, 2007Decker S. Integrating guided reflection into simulated learning experiences.in: Jeffries P. Rizzolo M.A. Using simulations in healthcare: The core essentials in getting started. National League for Nursing, New York2007Google Scholar). Simulation Experience: Term often used synonymously with simulated clinical experience or scenario. Simulation Learning and Testing Environments: Simulation Learning Environment: An atmosphere that is created by the facilitator to allow for sharing and discussion of participant experiences without fear of humiliation or punitive action. The goals of the simulation learning environment are to promote trust and foster learning. Simulation Testing Environment: An atmosphere that is created by the facilitator to allow for formative or summative evaluation to occur. The goals of the simulation testing environment are to create an equivalent activity for all participants in order to test their knowledge, skills, and abilities in a simulated setting. Skill Acquisition (Skill Attainment): After instruction, the ability to integrate the knowledge, skills (technical and nontechnical), and attitudes necessary to provide safe patient care. The individual progresses through five stages of proficiency: novice, advanced beginner, competent, proficient, and expert (Benner, 1984Benner P. From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley, Boston, MA1984Google Scholar, Benner et al., 1996Benner P. Tanner C.A. Chesla C.A. Expertise in nursing practice: Caring, clinical judgment and ethics. Springer, New York1996Google Scholar). Skill Development: The progress along a continuum of growth in knowledge, skills, and attitudes as a result of educational or other experiences. Standardized Patient: A person trained to consistently portray a patient or other individual in a scripted scenario for the purposes of instruction, practice, or evaluation (Robinson-Smith et al., 2009Robinson-Smith G. Bradley P. Meakim C. Evaluating the use of standardized patients in undergraduate psychiatric nursing experiences.Clinical Simulation in Nursing. 2009; 5: e203-e211https://doi.org/10.1016/j.ecns.2009.07.001Abstract Full Text Full Text PDF Scopus (90) Google Scholar). Typology: Classification of types. In simulation it refers to the classification of different educational methods and/or equipment used to provide a simulated experience. For example, simulation methodologies may include written simulation cases, 3-dimensional models, computer software, standardized patients, partial task trainers, or high-fidelity patient simulators. Validity: The degree to which a test measures what it is supposed to measure.