NUR6033 Module 5 technology implementation plan example

From One Pilot to Three Courses: Implementing a Standardized Patient Program Over Two Years, With a Line-Item Budget, a Faculty Preparation Path and the CFIR Domains as a Checklist for What Could Stall It

Student Name

American College of Education

NUR6033: Innovation in Nursing Education

Module 5 Assignment

Instructor Name

August 5, 2030

What Is Being Implemented

The pilot of the Marcus encounters ran in the fall mental health course with 60 students. Faculty ratings showed that 71% of students met all four objectives in the second encounter, compared with 38% in the first, and students rated the experience as the most useful in the course. The curriculum committee has asked me to expand standardized patient encounters to two further courses over two years: the health assessment course, for a history-taking and communication encounter, and the senior leadership course, for an encounter in which the student must deliver difficult news to a family member. Expanding from one course to three is a different task from running a pilot. The pilot relied on my time and enthusiasm; a program must survive without either.

Readiness and Framework

Two sources shape the plan. The NCSBN simulation guidelines for prelicensure programs describe what a program needs before relying on simulation: commitment from the institution, adequate resources and facilities, faculty prepared in simulation pedagogy including debriefing, and simulation designed and evaluated using recognized standards (Alexander et al., 2015). Against those guidelines, our program is partly ready: we have space and standards-based design, but only two faculty have debriefing training and no budget line exists for actors.

The Consolidated Framework for Implementation Research organizes the factors that affect implementation into five domains, covering the intervention itself, the setting outside and inside the organization, the people involved and the process by which implementation is carried out (Damschroder et al., 2009). I used the domains as a checklist of what could stall the program. Intervention characteristics: standardized patients are more complex and costly than manikins, which could make them easy to cut. Outer setting: the psychiatric partner's reduced placements create pressure that favors the program. Inner setting: faculty workload is high, and debriefing takes time. Individuals: some faculty are skeptical of simulation replacing clinical time. Process: the pilot had one champion; the program needs several. A program that depends on one coordinator is a pilot that has not ended yet.

Justifying the Cost

Standardized patients cost more per hour than manikins, and the plan must justify that. Cost should be compared against outcomes, not in isolation. A cost-utility analysis in nursing education found that medium-fidelity manikins produced the same clinical reasoning, knowledge and satisfaction outcomes as high-fidelity manikins at about one fifth of the cost per student (Lapkin & Levett-Jones, 2011). The principle cuts both ways: expensive fidelity is not justified when a cheaper modality achieves the same outcome, but it is justified when the outcome requires it. For communication with a person who responds in real time, as Module 1 showed, a manikin cannot achieve the outcome at any price. The relevant comparison is therefore between standardized patients and other ways of teaching conversation, and none of our alternatives achieved the pilot's gains.

Phases and Budget

Year one adds the health assessment course, 120 students each taking one 20-minute history encounter with debriefing, and continues the mental health encounters. Year two adds the senior leadership course, with 110 students each delivering difficult news to a standardized family member. The budget per year at full implementation is: actor time, 60 hours for mental health, 50 for health assessment and 45 for leadership, plus 40 hours of training, at $55 an hour, about $10,700; a part-time standardized patient trainer at ten hours a week for 40 weeks at $35 an hour, $14,000; video recording software licenses for debriefing, $3,500; and supplies, $500. The total is about $28,700 a year, or about $61 for each of the roughly 470 student encounters across the three courses. The dean has agreed to fund year one from the simulation budget and the savings from the declined virtual reality package, and to include a permanent budget line from year two if the evaluation shows results.

Preparing Faculty

Faculty preparation addresses the barrier in the individuals and inner setting domains. Each course that adds encounters will have two faculty trained as debriefers through the four-hour workshop and supervised co-debriefing described in Module 3, so that six more faculty are prepared over the two years. Skeptical faculty will be invited to observe a mental health encounter and debriefing before their course adopts one; in the pilot, two faculty who observed became advocates. Debriefing time will be counted in faculty workload at the same rate as clinical supervision, which the associate dean has approved, which removes the program's reliance on goodwill. And a simulation committee of three faculty, one from each course, will share responsibility for scheduling, actor recruitment and quality review, replacing the single champion.

Communicating the Change

Implementation fails as often from surprise as from lack of resources, so the plan includes a communication schedule for each group affected. Students will learn about the encounters in each course syllabus and in the program orientation, with a short video from the pilot showing what an encounter and debriefing look like, since students who know what to expect are less anxious and use the experience better. Faculty in the two new courses will receive the scenario drafts a full term ahead and will review and revise them, so that the encounters belong to the course rather than being delivered to it by the simulation center. Clinical partners will be told through the advisory board that standardized patient encounters are being added, and how they complement rather than replace clinical hours, since partners sometimes read simulation as a sign that the program needs fewer placements. The dean and curriculum committee will receive a one-page report each term with the evaluation measures and budget spent against plan. Finally, the actors themselves are stakeholders. They will receive feedback on their portrayals, be invited to an end-of-year meeting to suggest improvements to the cases and be credited in program materials. A program that treats its standardized patients as part of the teaching team is more likely to keep them, and keeping trained actors is the single largest saving the program can make.

Risks and How Progress Will Be Judged

Three risks are most likely. Actor recruitment may fall short, since the region has no established standardized patient pool; the trainer will recruit through the university's theater department and community groups, and each course will have two backup actors. Scheduling may conflict with clinical rotations; encounters will be scheduled in blocks at the start of each term before clinical schedules are finalized. And budget may be cut in a difficult year; the evaluation data will be the defense. Progress will be judged each term by the proportion of students meeting each encounter's objectives, student ratings, debriefing quality ratings and the number of trained faculty, reported to the curriculum committee. At the end of year two, the committee will decide whether the program becomes permanent.

References

Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kardong-Edgren, S., Kesten, K. S., Spector, N., Tagliareni, E., Radtke, B., & Tillman, C. (2015). NCSBN simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), 39-42. https://doi.org/10.1016/S2155-8256(15)30783-3

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

Lapkin, S., & Levett-Jones, T. (2011). A cost-utility analysis of medium vs. high-fidelity human patient simulation manikins in nursing education. Journal of Clinical Nursing, 20(23-24), 3543-3552. https://doi.org/10.1111/j.1365-2702.2011.03843.x