Jocelyn Ludlow, director of simulation at the Sue & Bill Gross School of Nursing, is reveling in the opportunities offered by the school’s brand new 9,500-square-foot simulation facility. She takes obvious delight in demonstrating the simulated hospital teaching environment, the manikin bodies and body parts, the multiple consultation rooms and spacious breakout areas. However, the pedagogic basis of her enthusiasm dominates as she explains the distinct role of simulation in the education of nurses.
Simulation is not a substitute for clinical experience: it’s an addition to the teaching repertoire. It’s a different kind of learning.
Jocelyn Ludlow
“Nurse training has always involved simulation. It’s not about tech,” she says, “although the tech keeps getting more accessible and better. Depending on the scenario, low fidelity tech may be sufficient and the psychological fidelity required is high – think about breaking bad news to the relative of a patient. That’s why sim people always ask: ‘What are your objectives? What do you want the students to learn?’ In a simulated situation they’re not student nurses – they are the nurses. Students get to show they can make decisions in a learning environment that feels real, but it’s psychologically safe.”
Psychological safety for learners is an important focus of Ludlow’s work and approach. If simulation has changed rapidly in recent years, it’s not necessarily because of technological advances, even though the verisimilitude provided by a state-of-the-art sim lab is eerily accurate. It’s more to do with changing attitudes and knowledge about how students learn best: a revolution in which Ludlow is pleased to play her part, having co-authored the national healthcare standard of best practice for pre-briefing and simulation design. Pre-briefing, in particular, is her area of expertise, as she explains:
“Nursing schools used to ambush learners – drop them into simulated situations and give them a shock. But there’s no harm in being prepared for what’s going to happen! In the end, you’re going to have to make the same decisions, so my focus has been on what will make the students feel safe so they can give their best. And they validate me every time. They identify hidden objectives. They’re able to make their best decisions. They work in teams and learn to be aware of what their colleagues do. Students really dislike the ambush approach – they want to know which direction to walk in.”
It’s such a different modality to an instructor who’s used to being in a clinical session with students, where they have to keep them from making the wrong choice.
Jocelyn Ludlow
She also emphasizes the importance of pre-briefing in helping instructors to adapt their behavior by preparing them for situations in which they feel safe to trust their students. “It’s such a different modality to an instructor who’s used to being in a clinical session with students, where they have to keep them from making the wrong choice.”
Analysis of the student’s actions during a simulated scenario comes afterwards, at the debriefing. Again, Ludlow’s approach is always student-centered, as she advises: “Debriefing is where the learning happens – so don’t start lecturing! It’s where you ask, ‘What would you have done differently?’ That’s when you can point out what might have been more effective.”
It’s perhaps no surprise to discover that Ludlow “always intended to be a teacher,” and her original scholastic interest was in literature: she uses her keen sense of narrative every day, and describes setting up simulations as, “telling a story: something is going to happen, it’s going to unfold. It’s like those ‘choose your own adventure’ books.”
However, as a young person she opted for nursing and spent nine years as a bedside nurse, mainly in cardiology. “I’ve seen a lot of things,” she says. “I can teach and talk about a thing in its real context.”
One day, while working at a military hospital, she heard “screaming – and I went right into the room – I’m brazen! – to see what was going on.” Opening the door, she found herself “in the middle of a full combat medical situation, complete with camo net hanging from the ceiling and a patient with no heartbeat” – and was immediately hooked. She went back to school and began her journey towards becoming a nursing simulation specialist and nationally recognized expert in simulation pedagogy.
Debriefing is where the learning happens – so don’t start lecturing! It’s where you ask, ‘What would you have done differently?’
Jocelyn Ludlow
Having spent two years of the Covid pandemic as a director of simulation in Seattle, Ludlow decided to return to her native California and the Sue & Bill Gross School of Nursing in part because, she says, “it intrigued me: it’s smaller, it’s more receptive to growth and innovation – and the new building is really something!” Since taking up her role, she has been “blown away by how enthusiastic the faculty are about sim – there’s been a big pivot in attitudes within the nursing profession.”
Despite her recognition that simulation represents a different dimension of learning to genuine clinical experience, it’s possible that the circumstances of the pandemic have opened more people’s eyes to the untapped potential of sim. Ludlow comments that, following Covid lockdowns – when finding hospital-based clinical experiences for nursing students presented a massive challenge – schools of nursing across the nation relied on earlier findings by the National Council of State Boards of Nursing to allow for more simulation in the clinical education of nursing students. The 2014 study* showed minimal differences between hospital-based and simulated clinical learning experiences.
Furthermore, Ludlow sees considerable “interprofessional potential” in the use of the sim lab, which can just as easily enable ready-qualified professionals to “work side by side with partners in other disciplines” to experience and analyze team behavior as part of ongoing professional development.
“After all,” she points out, “simulation is not just for nursing. Any industry that needs to prepare for safety in low frequency, high risk situations has been using it for years: medical, veterinary, the army, the airline industry.”
From her own attitude to her work, though, it’s clear that Ludlow is, and will always be, a nurse. In summarizing her approach, she recalls a past mentor who advised her to “think of the students as your patients – you’ve got to want them to succeed, to get better in their own way. Be empathetic and respect that they’re adults.”
She looks around at the rows of hospital beds, the monitors, the manikin patients of differing ages and ethnicities awaiting their treatment at the hands of trainee nurses. “It was a great choice to come here,” she smiles. “I’ve got lots of ideas, and there’s so much to do.”
Here what our Students say.
Jamie Rae Garcia, first year DNP
Jamie Rae Garcia is a nurse and a community organizer. “After I got my [first] degree in nursing,” she explains, “I promised myself I would become more politically active.”
For more than a decade, she has pursued that aim. Jamie is an oncology medsurge nurse at a hospital in East Los Angeles, close to Skid Row. Her focus, in her paid work and as a volunteer with the Los Angeles Community Action Network, is on health, food, criminalization and social justice.
These concerns were a significant factor in her choice of the Sue & Bill Gross School of Nursing for her DNP. “Everyone at the school welcomed the fact that I’m fairly vocal about my work,” she says. “I can express myself politically here. The professors were very available, setting me up with other professionals, offering to put me in touch with researchers whose work is relevant to mine on Skid Row.”
I’m here to unlearn what I grew up thinking, and to learn about the privilege I carry into the room.
Jamie Rae Garcia
Unexpectedly, it was Jamie’s teenage desire to work with horses that led to a career in caring – and indeed, to organizing. Having quit college, she eventually found a role at a non-profit organization providing horse-based therapy for children and adults with autism and varying disabilities. In her words, she was “working with the horses so that kids could work with the horses,” and her interest in the kids only grew.
For many years following, until she trained as a nurse in her 30s, she worked with people in need of care in settings that ranged from residential care to mental health services. With every role she undertook, Jamie sought to educate herself about the experience of disadvantage in America, beginning with the history of institutionalizing the disabled.
“It was very intriguing to me to see how we care for people who are disabled, who are not considered productive and therefore seen as not worthy of much help. It seemed to me that a certain type of person is valued and if you don’t reach that category – because you’re disabled, or poor, or queer, or you’ve been locked away in an institution – you start to fall down each rung of the ladder.”
Her growing sense of the complex, historic nature of such injustices led to her increasing involvement in community advocacy. This, she points out, means working “in partnership with the community as a facilitator, a voice, in unison with them.” Now an experienced nurse and soon to be a DNP, she has “no plan to quit this work,” she says.
However, her voluntary efforts remain distinct in her mind from her primary role as a direct healthcare provider. “We don’t have a strong foundation in delivering culturally competent care,” she declares. “I want that to be talked about. I’m here to unlearn what I grew up thinking, and to learn about the privilege I carry into the room. My patients need a direct care provider who sees their humanity and who wants to see them return. I can do that for them.”
Alex Jones-Patten, PhD (’22)
“I’ve always been a lover of the heart,” says Alex Jones-Patten, explaining the topic of her recent PhD at the Sue & Bill Gross School of Nursing. “It’s delicate and intricate, but smart and strong.”
After qualifying from nursing school in 2017, Alex worked in a hospital telemetry unit in Fountain Valley, CA. This gave her plenty of opportunity to contemplate the challenges faced by that smart, strong organ, and to get curious about what lies behind the higher risk of cardiovascular disease in the African American population, and other minority groups, when compared with people of Caucasian origin. From her daily interactions with patients, it was clear that, in terms of heart health, “the education piece is just not sinking in.”
Working with patients to try and “provide actual options” that would help them care for themselves, Alex could see that the challenges many of them faced were more than enough to explain their low rate of adherence to a heart-healthy lifestyle. She wanted to investigate further – first, to test her hypothesis about links between discrimination, patient behavior and cardiovascular disease, and second, to begin to propose possible solutions.
These questions lie at the root of her PhD, which – she explains – uses a mixed-methods study to examine options for cardiovascular disease prevention in Black subjects, specifically those who face adverse circumstances, such as homelessness, that place them in a “double minority.”
Alex Jones-Patten
The research that’s happening now will inform policy when our kids have kids!
In 2019, when Alex first opted to pursue her PhD with the Sue & Bill Gross School of Nursing, it was a “pretty new program” she comments – but she feels fortunate that she chose to join the school. “I’m not sure any other program would have given me so much opportunity to grow as a nurse scientist,” she says. “The team is small but mighty, and collectively, they want you succeed – the faculty, the administration, everyone.”
Although she had always wanted to be a nurse, Alex originally worked as a preschool teacher because, she says, “I could not get through the science classes!” Luckily, despite her initial lack of confidence, she persisted and prevailed. “I just knew I was going to be a nurse practitioner. And once I got a taste of research – that sparked some real drive for me.”
Her PhD completed, Alex is moving on to Columbia University as a postdoctoral researcher in cardiovascular disease prevention in African Americans. “There’s still a lot to uncover,” she says. “My hope is that we do develop interventions that are specific to people who identify as a double minority. The research that’s happening now will inform policy when our kids have kids!”
