Collegian (2012) 19, 177—186

Available online at www.sciencedirect.com

jo ur nal homep age: www.elsev ier .com/ locate /co l l

Clinical simulation in Australia and New Zealand:Through the lens of an advisory group

Roy A. Brown, RN, DPSN, PGCE (Adult), BA, PGDMS, MA, PhD (Candidate)a,∗,Stephen Guinea, BN, GradDip T&D, MEd (Candidate)b,1,Patrick A. Crookes, PhD, BSc, Cert Eda,2, Margaret McAllister, Ed D, RN,MHN, BA, MEDDipAppSc (Nursing)c,3, Tracy Levett-Jones, PhD, RN, MEd &Work, BN, DipAppSc (Nursing)d,4, Michelle Kelly, MN, BSc, RN,PhD (Candidate)e,5, Kerry Reid-Searl, PhD, MClin.Ed, BHlthSc (UCQ), MRCNA,FCN, RN, RMf,6, Christopher Churchouse, RN, PhDg,7, Patrea Andersen, PhD,MA(Ng), BHSc(Ng), ADN, RNa,8, Nigel Chong, RN, BN, Dip.Par.Sci,Cert.IV.WT&A, ACRM, MRCNA, MASSH, MSA, MACAPh,9, Andrew Smith i,j,10

a University of Wollongong, Australiab Australian Catholic University, Australiac University of the Sunshine Coast, Australiad University of Newcastle, New South Wales, Australiae University of Technology, Sydney, Australiaf Central Queensland University, Australiag Clinical and International Nursing, Edith Cowan University, Australiah University of Tasmania, Australiai Laerdal, Australia

j Laerdal, New Zealand

Received 19 October 2011; received in revised form 12 May 2012; accepted 19 May 2012

∗ Corresponding author. Tel.: +61 2 4221 3227; fax: +61 2 4221 3137.E-mail addresses: royb@uow.edu.au (R.A. Brown), Stephen.Guinea@acu.edu.au (S. Guinea), pcrookes@uow.edu.au (P.A. Crookes),

mmcallis@usc.edu.au (M. McAllister), Tracy.Levett-Jones@newcastle.edu.au (T. Levett-Jones), Michelle.Kelly@uts.edu.au (M. Kelly),k.reid-searl@cqu.edu.au (K. Reid-Searl), c.churchouse@ecu.edu.au (C. Churchouse), patreaa@uow.edu.au (P. Andersen),Nigel.chong@utas.edu.au (N. Chong), Andrew.Smith@laerdal.com.au (A. Smith).

1 Tel.: +61 3 9953 3857; fax: +61 3 9953 3385.2 Tel.: +61 2 4221 4208.3 Tel.: +61 7 5456 5032; fax: +61 7 5459 4767.4 Tel.: +61 2 4921 6599; fax: +61 2 4921 6301.5 Tel.: +61 2 9514 4815.6 Tel.: +61 7 4930 9741.7 Tel.: +61 8 6304 3503; fax: +61 8 6304 2277.8 Tel.: +61 2 4221 3356; fax: +61 2 4221 3137.9 Tel.: +61 3 6324 3458; fax: +61 3 6324 5010.

10 Tel.: +61 3 9569 4055; mobile: +61 418 741 271.

1322-7696/$ — see front matter © 2012 Royal College of Nursing, Australia. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

http://dx.doi.org/10.1016/j.colegn.2012.05.002

178 R.A. Brown et al.

Summary: Across Australia, innovations in simulation to enhance learning in nursing have beenoccurring for three decades and nursing is, and needs to be, a leading player in simulation knowl-edge diffusion. However, expertise is unevenly distributed across health services and educationproviders. Rather than build on the expertise and achievements of others, there is a tendency forresource duplication and for trial and error problem solving, in part related to a failure to com-municate achievements for the benefits of the professional collective. For nursing to become aleader in the use of simulation and drive ongoing development, as well as conducting high qualityresearch and evaluation, academics need to collaborate, aggregate best practice in simulationlearning, and disseminate that knowledge to educators working in health services and higher edu-cation sectors across the whole of Australia and New Zealand. To achieve this strategic intent,capacity development principles and committed action are necessary.In mid 2010 the opportunity to bring together nurse educators with simulation learning expertisewithin Australia and New Zealand became a reality. The Council of Deans of Nursing and Midwifery(CDNM) Australia and New Zealand decided to establish an expert reference group to reflect onthe state of Australian nursing simulation, to pool expertise and to plan ways to share bestpractice knowledge on simulation more widely.This paper reflects on the achievements of the first 18 months since the group’s establishmentand considers future directions for the enhancement of simulation learning practice, researchand development in Australian nursing.

KEYWORDSCapacity development;Nursing;Simulation;Simulation LearningEnvironment;Pedagogy

© 2012 Royal College of Nursing, Australia. Published by Elsevier Australia (a division of ReedInternational Books Australia Pty Ltd). All rights reserved.

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imulations are designed to amplify (Gaba, 2004), mimicr replace real-life situations, giving participants opportu-ity to reason their way through clinical problems and makeecisions, without the potential for harming actual patientsBond & Spillane, 2002). Simulations are not new. They haveeen used in military and aeronautical training since Postorld War II very successfully, producing low failure rates

Gaba, 2004) and increasingly used as a teaching tool in theducation of health professionals, particularly medical andursing students, over the past three decades. When time isf the essence, and opportunities to experience and practice

range of health skills are constrained, simulation learningffers exciting potential to maintain rigour and quality inlinical learning.

With the intent of sharing important information andnsights about developments in simulation nationally andnternationally, this paper first discusses the value of sim-lation and why it is a particularly ‘hot topic’ at present.t then goes on to inform the reader of current activityn Australia in particular, driven in part by the Council ofeans of Nursing (CDNM ANZ) Simulation Learning Environ-ent Advisory Group. A particular focus on work undertakeny the advisory group in collaboration with the Nationaleague for Nursing (in the US) and Laerdal, regarding theevelopment of a specific simulation resource and runningtaff development workshops.

he simulation imperative

ver recent years a number of critical changes have

ccurred within the health and education environments andheir momentum has gradually built, so that there is nowidespread acknowledgement of a critical situation in nurs-

ng education — a confluence of problems. The need to

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ncrease the numbers of health professionals being trainedlong with the concomitant challenge of identifying aufficient supply of clinical placement opportunities, has leftealth professional education and training with a currentlynbalanced equation.

There has been rapid growth in technologies in bothealth and education. Patients’ Length of stay in most spe-ialties in Health services is seemingly ever-decreasing (dearia, 2011), as people are being encouraged to self-manage

heir health care needs (Davidson, 2005). Further, whenatients are admitted to hospital their conditions are morecute and their needs much more intense. At the sameime, there has been a prolonged and unabating shortage ofealth professionals in every field (Del Mar & Dwyer, 2006)nd alarming reports of poor risk management and threatso patient safety in most countries in the developed worldWorld Health Organisation, 2005). Health care consumersave been becoming more informed, active and expectantf care that is of high quality and that practitioners deliv-ring that care are accountable (WHO, 2005). Thus, healthrofessionals are in the situation where clinical services arender a great deal of pressure to maintain standards, andhus the time available to support students is constrained.

For much the same reasons, the education sector is alsonding it difficult to meet its quality agenda (Potempa,edman, & Landstrom, 2009). Higher numbers of studentsre needed to fill growing workforce shortages. For studentso reach competence in complex health fields they needore intensive, effective learning experiences; and yet the

linical placements required for comprehensive learning areifficult to secure (HWA, 2010). In the current health land-cape, it is no longer guaranteed that students will be ableo access the clinical environments’ necessary to master the

kills they will need as graduates (Baxter, Akhtar-Danesh,alaitis, Stanyon, & Sproul, 2009). Simulation learning isherefore no longer simply a creative adjunct for studentearning, it is an imperative.

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Clinical simulation in Australia and New Zealand

Strengths and challenges of simulationlearning

In order to focus innovation and research in simulation learn-ing in nursing in Australia, it is important to first considerstrengths and challenges that simulation learning offers, toappreciate international research activities in the area andfor Australian Nursing to strategically and effectively con-tribute to the field. Nehring and Lashley (2005) succinctlycapture the literature illustrating the key points of evidenceof both research and scholarly commentary (see Table 1).

Simulation Learning Environments provide the potentialto amplify key learnings necessary for developing compe-tency in health care contexts. This is particularly importantfor those areas where sufficient clinical placements are dif-ficult to secure, e.g. acute mental health, intensive careand in community agencies.

Another possible benefit, yet to be firmly establishedwith evidence, is that in some cases, simulation learn-ing may actually be superior to learning that occurs inthe clinical setting. Advocates argue that poorly super-vised, uncontrolled clinical learning can be subject to thevagaries and complexities of busy health environments(Baxter et al., 2009; Papp, Markkenen, & von Bonsdorff,2003). In this situation, some students receive a satisfac-tory, comprehensive experience with all their learning needsmet, whilst others do not. Simulation may therefore offera more controlled learning environment, where every stu-dent can be guaranteed to engage in the learning processesintended for them and perhaps be expected to demonstratecompetence. An ongoing study in the USA is being led byProfessor Pamela Jeffries the Project Director for a nationalsimulation study funded by the National League for Nursing(NLN) and the Laerdal Corporation. This study is being con-ducted across eight geographic sites over a three year periodand is considering the impact of replacing aspects of clinicalpractice learning with simulation learning. Study outcomesare likely to impact internationally on nursing, and possibly,other health care professional programmes.

A challenge for simulation learning is the high financialcosts of establishment and then ongoing costs re staffingand resources. The costs relate to staff development, cap-ital investment of the spaces and resources for simulationdelivery, as well as curriculum design, or re-design (Lapkin& Levett-Jones, 2011). Reported initial investment costs onsimulation equipment (Adamson, 2010) in the US suggestsbetween US$ 51,000 to US$ 300,000; with individual pur-chases ranging between US$ 30,000 to US$ 150,000 for a highfidelity manikin (Gant, 2007) and maintenance and trainingaround US$ 2000 to US$ 5000 per annum (Adamson, 2010).This is not money well spent if users of the technology arenot well trained, hold ambivalent opinions about the ben-efit of simulation, or perceive role overload or role strainassociated with the expectation to incorporate simulationexpertise into their skill set. Many already perceive thegrowing skill set extends beyond reasonable expectationsin academia. Students report their experiences of simula-

tion learning as generally positive (Levett-Jones et al., 2011)however its effectiveness remains uncertain. There are alsomany different kinds of simulation and it is not clear howthey compare in terms of student satisfaction or efficacy.

aapa

179

onetheless, Cook et al’s (2011) recent systematic reviewoncluded that

‘‘. . . in comparison with no intervention, technology-enhanced simulation training in health professionseducation is consistently associated with large effects foroutcomes of knowledge, skills, and behaviours and mod-erate effects for patient-related outcomes.’’ (p. 978)

This is an important rationale for concerted continuingmprovement, creative innovation and systematic evalua-ion in simulation learning in nursing education.

imulation learning pedagogy

ne key difference between learning that occurs in thelinical setting and learning within a Simulation Learningnvironment is the ready availability of educators and othertudents (in the latter) who can act as peer teachers toupport the learner. Another difference is that errors areot only safe to occur in this setting, they can be specif-cally built into the pedagogy as a means of attaining andssessing competence. In both settings, learning can occurhrough legitimate peripheral participation (Lave & Wenger,991), from observing the practice of others; but in a clin-cal setting it is unlikely that the learner (or educator) canasily interrupt practice for explanation or revision. In theimulation setting, it is appropriate to create space andime for reflection on practice. This is something that mayot occur in the clinical setting and so opportunities tonternalise learning and thus for it to be retained, may beost.

This overview has considered the general advantages andisadvantages of simulation learning (see Table 1). Nursing is

large user of simulation, and therefore potentially a largeontributor to innovation and research. To move forward it ismportant that leaders in this area come together to develop

shared vision and united voice.

aking the simulation agenda forward inustralia

n Australia the Council of Australian Governments (COAG)nvested a significant sum into the development ofimulation-related resources nationwide. A total budget inxcess of AUD$ 95 million was identified. This funding oppor-unity, led the Council of Deans of Nursing & Midwifery forustralia and New Zealand (CDNM ANZ) to create a Simula-ion Learning Environment (SLE) Advisory Group to considerhe issues outlined in the previous section of this paper. Thedvisory group were to make recommendations to Coun-il on ways forward so that energy, and more importantlynancial resources, could be appropriately targeted to meethe needs of integrating simulation learning in structurednd meaningful ways. The designated group structure will

lso provide an opportunity to consider areas for researchnd evaluation which may contribute strategically to futurelanning and development both nationally and internation-lly.

180 R.A. Brown et al.

Table 1 Advantages and disadvantages of simulation learning.

Advantages of simulation Disadvantages of simulation

Simulation involves active learning Simulation is time consuming to develop and implementFaculty can develop simulation activities that reflect

course outcomesFor faculty simulation maybe an unfamiliar mode of teachinginitially

Simulation increases knowledge, communication skills,motivation, confidence and effective learning

Evidence for effectiveness: is this context bound? In what casesmay it be equal or superior to real world clinical learning?

Simulation improves critical thinking Cost and maintenance of technology and resourcesAllows hands on practice and repetition Pedagogically young and thus lacks focus, requires trial and errorSimulation provides instant feedback and fosters

reflection on practice, critical thinking and transfer oflearning

Gaming, virtual and alternate reality simulation may come morenaturally to the learners than the educators

Maximises effective time in real world setting bydecreasing anxiety

Limited numbers of students can be actively involved at one time

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stablishing the group

nitially the chair of the CDNM ANZ, through Council, iden-ified key players from universities who had ‘runs on theoard’ using simulation within their programmes. Thesendividuals were from different Australian states and ter-itories and brought a depth and breadth of knowledge tohe table about simulation learning. Expertise ranged fromsing high fidelity manikin based scenarios, through to thosetilising pedagogies that incorporated actors and forms ofole play. Quite quickly, an opportunity arose to work withaerdal in Australia, to ‘Australianise’ a series of case stud-es initially developed by the NLN in the USA. This caseaterial had evaluated well within US nursing programmes

nd the anglicised materials were now being used in UKchools of nursing; hence the drive to review and then adapthe materials for use in Australia and New Zealand.

The range of expertise, complimented by Laerdal,ffered the opportunity for sharing and learning about bestractice in simulation, based on the experiences of theLE group members. This created an enriching opportunityor group members to learn about each other’s successfulpproaches to using simulation learning. As a consequencehe group began to consider broader conceptual issues thatnderpinned all modalities under the simulation umbrella.bvious examples included an overarching pedagogy or cur-

iculum model for generating and documenting scenariosnd approaches to ‘debriefing’; the exploration of strate-ies and models for these important aspects of simulationedagogy proved to be a useful starting place.

ey plans and strategic intentions of the CDNMLE Group

nitial exploration was ‘what is each group members’ univer-ity doing in simulation at the moment?’ Although this was

ot to be viewed as an accurate, nor complete view of simu-ation in Australia and New Zealand, it served the purpose ofeginning an individual and group agenda, setting out wherehe assembled expertise was at that point in time, using theroup’s collective expertise.

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erminology and the level of technology

he first area to stimulate discussion was the relativelyharp polarisation between the valuing of high technicaldelity simulation and simulation that uses low technologypproaches such as actors or role play. In the latter theearning may well be just as deep (Marton & Säljö, 1976) andnable critical thinking, problem solving and clinical reason-ng to be further developed, but the level of technology usedif any) would be low.

The SLE Advisory group are of the view that significantork needs to be done to separate out the connotationsf high fidelity simulation experiences from the use of highech devices such as manikins. This seems to be an obviousmperative as the literature often differentiates high fromow fidelity in a ‘technical’ way, referring to the equipmentnd a broad view on the nature of the learning. Weaver forxample states that:

‘‘Low-fidelity patient simulation refers to individualmanikin parts that are used simply as task trainers toteach students specific psychomotor skills. Medium (orintermediate)-fidelity patient simulation uses manikinsthat can be somewhat computerized; these offer oppor-tunities to practice specific psychomotor skills butlack the complexity and realism of patient scenarios.’’(Weaver, 2011:38)

Alternatively, some authors suggest that fidelity referso how authentic or life-like the manikin and/or the sim-lation experience is (Lapkin & Levett-Jones, 2011). Suchefinitional diversity is important to acknowledge. Nursingducation needs to clarify that students need to learn duringimulation (e.g. clinical psychomotor skills, critical think-ng/clinical reasoning skills, communication or teamworkkills) and align this with the most effective pedagogy. Nurs-ng then needs to clarify how it intends to define and utiliseow and high fidelity learning experiences. The CDNM SLEroup intends to refine and localise a taxonomy of terms

elated to important concepts in simulation, over the next2 months. This will be informed by the seven standardsAckerman, 2011) developed by the International Nursingssociation for Clinical Simulation and Learning (INACSL).

Clinical simulation in Australia and New Zealand 181

Table 2 NLN/Laerdal scenario topics.

Surgical scenarios Medical scenarios

1Lower Leg Fracture — Basic Assessment Acute Strep Throat — Mild Reaction to AntibioticLower Leg Fracture — Compartment Syndrome Pneumonia — Severe Reaction to Antibiotic

2Preoperative Bowel Obstruction — Spiritual Needs Mild AsthmaPreoperative Bowel Obstruction — Fluid and ElectrolyteImbalance

Severe Asthma

3Immediate Postoperative Abdominal Hysterectomy —Managing Nausea

Chronic Obstructive Pulmonary Disease — OxygenTherapy

Immediate Postoperative Abdominal Hysterectomy —Opioid Intoxication

Chronic Obstructive Pulmonary Disease — SpontaneousPneumothorax

4Postoperative Hemicolectomy — Preventing RespiratoryComplications

Angina

Postoperative Hemicolectomy — Pulmonary Embolism Acute Myocardial Infarction

5Postoperative Hip Arthroplasty — Blood Transfusion Diabetic — Insulin AdministrationPostoperative Hip Arthroplasty — Blood TransfusionReaction

Diabetic — Hypoglycaemia

National League for Nursing (NLN) (2007).

Another important issue which emerged from the ‘showand tell’ exercise was the range of simulation and the levelsof expertise of faculty across Australia and New Zealand.As a result, two initial foci of the group were identified: (i)to Australianise the NLN pack and (ii) to devise and deliverworkshops to prepare faculty to deliver simulation educa-tion.

Localising the NLN/Laerdal package simulationscenarios

In 2007 NLN and Laerdal (in New York) developed a packagefor use by nursing educators using the Laerdal SimManTM.This 20-scenario package (see Table 2) contained patientcases that addressed learning objectives applicable toundergraduate nursing programmes. The learning objec-tives provided a framework that would address major areasrelated to NCLEX-RN test plan categories and includedpatient assessment and management of nursing care aswell as other areas (see Table 3). It was acknowledgedthat in order for an effective and structured integrationof simulation into education programmes faculty wouldrequire assistance in a variety of forms when using highfidelity manikins. The NLN/Laerdal contained 10 medicaland 10 surgical cases. Each case comprised a core andcomplex scenario. The core level scenario reflected basicpatient assessment, safety, infection control, prevention

Table 3 Promoting learner development.

Patient assessment skillsIdentification of nursing diagnosisManagement of nursing careImplementation of appropriate interventionsEvaluation of performance using guided reflection.

National League for Nursing (NLN) (2007).

of complications and communication. The complex levelscenario contained greater complexity of the same patientcase but challenged students on the recognition and man-agement of complications, the ability to collaborate; workin a team; communicate and coordinate complex care.

This pack of comprehensive simulation scenarios and sup-port materials was to be modified by the CDNM SLE Advisorygroup to locate the scenarios within the Australian and NewZealand health care contexts. The NLN/Laerdal pack con-tent was reviewed and revised by teams of academics andclinicians in order to localise language, practice and incor-porate relevant cultural competence and cultural safetyelements.

Opportunity to test the case scenarios with clinicians,although time consuming, was invaluable as it gave the SLEAdvisory group the opportunity with clinicians and academiccolleagues for validity and clinical currency. Part of thisexploration led to the identification of key elements thatbecame part of the development workshop, which wouldform a second area of focus for the group.

The NLN/Laerdal Simulation in Nursing Education casescenarios contains instructor resources that assist faculty toidentify and locate the most appropriate simulation expe-rience to meet identified student outcomes. The structure

Table 4 Structure of the NLN/Laerdal Simulation in Nursingmaterials.

Scenario overviewLearning objectivesNursing Assessment and Nursing Diagnoses which includes:

Equipment Checklist; Prep of the SimManTM SimulatorRequirements to prepare simulationInformation for facultyOutline of assessment and managementDebriefing/guided reflection guide

National League for Nursing (NLN) (2007).

182 R.A. Brown et al.

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Figure 1 NLN/CD

an be seen in Table 4. The layout of each scenario providesnformation for the facilitator and student so it is clear howhe simulation will ‘‘flow’’. There is a ‘‘hand over reporto students’’ including relevant additional information. Thisype of material is often difficult to create; particularly fromovice faculty, but in this format provides a comprehen-ive pack. It is complemented by an equipment checklist;reparation of the manikin; the recommended number of

articipants and their roles, as a well as a detailed timedow chart of the SimManTM Settings, Actions, Events andues to assist the user in delivering the simulation and man-ging the simulator.

iait

cenario overview.

A sample NLN/CDNM/Laerdal case scenario can be seenn Figs. 1—3.

Fig. 1 shows the scenario overview and the related learn-ng outcomes, and a series of generic outcomes are alsodentified. Fig. 2 illustrates the ‘‘Hand over to the stu-ents’’, ‘‘Additional Information’’ and ‘‘Documentation’’.hese are common to the structure of all 20 scenarios inhe pack. Finally, Fig. 3 provides a focused debriefing that

s linked to the scenario content. No specific debriefingpproaches are recommended within the package, howevert is suggested that a recognised approach is used consis-ently. Debriefing is considered a key element in simulations

Clinical simulation in Australia and New Zealand 183

Figure 2 NLN/CDNM hand over to students.

cciTag

and forms one of the aspects covered within the ‘‘SLE Devel-opment Workshops’’ which will be explored in the nextsection of this paper.

Structure and purpose of the CDNM SLEDevelopment Workshops

The second phase of work from the CDNM SLE Group wasto devise a Simulation Learning Environment (SLE) Develop-ment Workshop to assist in the delivery of the NLN/CDNM

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ase scenarios. It also provides an opportunity to enhanceurriculum design and best practice for simulation teach-ng for representatives of Council member organisations.he work commenced by considering relevant literature,nd discussing existing work undertaken by members of theroup. This led to the identification of a number of key areashat might usefully be included in the SLE Development

orkshop. See Table 5.

The SLE Development Workshop comprised two days:ay 1 presents and explores ‘‘the context of simulation’’,

184 R.A. Brown et al.

Figure 3 NLN/CDNM student debriefing.

Table 5 2 Day programme of CDNM SLE Development Workshop.

Topic Key points

Day 1 content — critical conversations about simulationContext 1. Importance

2. Imperatives3. Drivers4. Motivators5. Challenges

Pedagogies of simulation How and why curriculum design is important

Critical factors required for success 1. Modes and models of delivery2. Debriefing3. Faculty development4. Costing models and value for money5. Aligning learning outcomes to resources

Current research in simulation Leaders nationally and internationally as well as the need to create and drivean evaluation and research agenda

Examples of simulation worldwide Linkages with international colleagues UK and US

Day 2 content — running a simulationRecap of Day 1

Conducting a simulation [This is runtwice as an active simulation event.]

1. Creating effective simulations2. Use of established Scenarios (CDNM/NLN)3. Creating buy-in with learners4. Debriefing using AV

Debriefing; How? Tips and tricksModels used Importance/Imperatives/Structure

Practical Do’d and Don’ts 1. Understanding some of the intricacies2. What ‘‘ifs’’?3. Tips and trick re: pre-/peri- and post-running simulations4. Using students (and other players) in simulation

Summary Questions and final key learnings

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Clinical simulation in Australia and New Zealand

‘‘what makes a good simulation?’’ and ‘‘pedagogies of sim-ulation’’ so that participants are able to view simulation inthe context of an entire nursing curriculum and within theAustralian and New Zealand context. Current research in thefield is also briefly highlighted in overview. Day 2 focuseson undertaking a simulation with the participants experi-encing this as learners within the activity. This approachprovides an opportunity to undertake a simulation with thesupport of clinicians (the participants) and experts in thefield (SLE Advisory group members). Structured debriefingassisted participants to optimise their learning and identifytake-home messages from the activities. This includes whatthey now know and what they need to find out more about.The workshops were intended as primers; to be seen as pro-viding a structured framework with hands on opportunities.Evaluations from the developmental workshops indicatedthat participants identified elements from which they havegained insight, knowledge and information and how they willshare those ideas with colleagues.

‘‘Excellent 2 day course, will take knowledge and skillsto simulation more effective at my college. Excellentnetworking opportunities’’

Evaluation of the two day workshop has demonstratedhigh participant satisfaction and produced helpful feed-back which is being integrated into subsequent workshopsto promote continuous quality improvement. All respon-dents identified; ‘good to excellent’ in terms of ‘applicationin their teaching practice’ following the workshops (allrespondent scores were good to excellent). Following upparticipants after the workshops will provide evidence ofthe utilisation of the learning and hence the effectivenessof the workshops.

Conclusion

Establishing a Simulation Learning Environment (SLE) groupwith a key industry partner, such as Laerdal, along withcollaboration with an international nursing organisation(NLN) has facilitated a number of opportunities to developresources and to explore opportunities for evaluation andresearch on simulation learning amongst nurse educatorsin Australia and New Zealand. The development workshopbased in and around a set of simulation resources, devisedfor the CDNM ANZ is another strategy to increase the qualityand quantum of the integration of simulation-based learningactivities into nursing curricula. Through these developmentworkshops, as well as to influence others to consider doingso it is anticipated that early users of simulation will bemotivated to increase the use of simulation as a learn-ing and teaching strategy in their programmes, as well asto persuade others to consider doing so. Through partner-ships such as the CDNM SLE Group and Laerdal; and ongoingopportunities with NLN simulation users will have increasedawareness and access to ready-made, validated and contem-porary simulation resources that are flexible to match any

entry level nursing curricula. Furthermore, by hosting intro-ductory workshops, the CDMN and Laerdal have provideda forum to enable local and national connections betweensimulation users and the SLE Advisory group and facilitate

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he conversation of sharing resources in what is currently aomewhat isolated and fragmented community.

International networks in health care simulation areeing strengthened through the SLE group’s work and thisill increase opportunities for research about the use of

imulation, of student learning and of faculty preparation.

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