Chapter 2: NLN Jeffries Simulation Theory

The Jeffries Simulation Theory and INACSL Healthcare Simulation Standards of Best Practice will also guide all the simulation experiences. The following content offers a comprehensive guide to the NLN Jeffries Simulation theory, its elements, and the core concepts that comprise it (Jeffries, 2016). 

 

Figure 2: NLN Jeffries Simulation Theory 

Context: The context of a simulation involves understanding the overarching setting in which it takes place. It considers whether the simulation is situated in an academic or practical environment and explores the distinction between in-situ, real-world settings, and controlled laboratory environments.

 

Background: The background of a simulation outlines its goals and specific expectations, influencing the design process. It looks at theoretical perspective that guides the curriculum and examines how it aligns with the broader curriculum. Finally, this phase considers the allocation of resources, including time and equipment.

 

Design: In the design phase, the specifics of the simulation are determined. This includes consultation with content experts, creating specific, measurable, attainable, relevant, time-limited (SMART) objectives, aligning the modality with the objectives, designing the scenario, addressing conceptual fidelity and ensuring physical fidelity through appropriate equipment and moulage. The design also includes strategies for pre-briefing and debriefing, developing an evaluation and plan, and pilot testing the simulation.

 

Feedback (Jeffries, 2021):

• Feedback in the form of cuing should be intentional.
• Conceptual Cues: helps participant achieve the instructional objectives of the simulation.
• Reality Cues: helps the participant clarify or navigate any gaps in the fidelity.

 

Sequencing (Jeffries, 2021):

• It is important that simulation has a clear beginning to end.
• Sequencing of elements within a simulation from briefing, simulation to debriefing is key.

 

Highlights that learners who participate in simulation before their actual patient-care experience demonstrate improved clinical outcomes.  It is important to sequence simulation from lower to higher fidelity to increase confidence.  Notes that if simulation is to be used for assessment, it must first be used for learning.

 

Fidelity (Jeffries, 2021):

• The choice of fidelity level should align with the simulation’s objectives, and transitioning from low to high fidelity has been associated with increased confidence.
• Recognizing multiple dimensions of fidelity (physical, conceptual, and psychological). It is recommended that the appropriate types and levels of fidelity align with simulation objectives.

 

Debriefing (Jeffries, 2021):

• Debriefing is deemed an essential best practice, particularly when working with novice learners in simulation.
• It is identified as the most crucial design feature of a simulation.
• Skilled debriefers are essential, and the ideal debriefing scenario may vary depending on the learners, facilitator, and context.
• There are various debriefing options such as face-to-face, numeric, graphical transcripts, video conferencing, checklists, scores, and other forms of feedback.
• There is a negligible difference between video and non-video debriefing methods.
• After virtual simulations, asynchronous debriefing is emphasized.

 

Simulation Experience: The simulation experience is characterized by an integrative, collaborative, learner-centered, and experiential environment. Establishment of trust is a shared responsibility between facilitators and participants. It is important to create a psychologically safe environment for everyone involved.

 

Facilitator and Educational Strategies: Facilitators play a crucial role in simulation success. Facilitation requires a high level of expertise. It is important for facilitators to have the following key attributes: skills, educational techniques, preparation, and training. Facilitation and facilitator roles are further discussed in Chapter 7 of this toolkit.

 

Facilitator Feedback (Jeffries, 2021)

• Feedback and expert modeling from facilitators, and feedback from peers improved participant learning and outcomes.
• Simulation activities should be learner centered (i.e., meet learner needs, promote engagement and consider environmental safety).
• Collaboration between learner and facilitator in planning, implementation and evaluation of simulation was helpful.

 

Participants: The participant phase considers various attributes, including age, gender, anxiety levels, and self-confidence. It also includes modifiable attributes like preparedness for the simulation and role assignment. It is important that participants should be oriented to the simulation environment. Participants are further discussed in Chapter 6 of this toolkit.

 

Observer Roles (Jeffries, 2021)

• Observer role is not passive but rather provides individual to engage and benefit from simulation in similar ways to more active participant.

 

Size of Groups (Jeffries, 2021)

• 4-6 participants with one facilitator and one manikin.
• Learning in pairs was more effective than individual learning.
• Small Groups were preferred over large groups.

 

Diverse Learning (Jeffries, 2021)

• Simulation appealed to various learning styles.
• Social learners benefit from interactive aspect of simulation.
• Solitary learners benefit from observation.

 

Outcomes: Outcomes of a simulation are categorized into three types: participant, patient, and system outcomes. Literature often focuses on reactions (learner satisfaction), learning (changes in knowledge, skills, and attitudes), and behavior (how learning transfers to the clinical environment). It is important to note that emerging literature also explores patient outcomes when caregivers are trained in simulation and organizational/system outcomes, such as cost-effectiveness and changes in practice.

 

Mastery Learning with Deliberate Practice (Jeffries, 2021)

• Mastery learning refers to competency-based educational strategies with standardized outcomes and deliberate practice refers to repetitive rehearsal to develop and maintain knowledge, skill and activity.
• Students that rained with mastery learning and deliberate practice showed increased improvement in patient care than those who were trained with traditional methods.