The Sim Cafe~ Interview with Dr. Laura Klenke-Borgmann

Laura Klenke-Borgmann PhD, RN, CHSE

Nurse Scientist, The University of Kansas Health System

Clinical Assistant Professor, The University of Kansas School of Nursing

Dr. Laura Klenke-Borgmann is currently the first nurse scientist for the University of Kansas Health System, where she integrates new graduate registered nurses into interprofessional sim approaches to care of the declining patient. She also conducts clinical simulation research and evidence-based practice initiatives that promote the advancement and innovation of nursing practice. In this role, she also serves as a mentor to colleagues in the clinical research process.

Dr. Klenke-Borgmann also has almost 15 years of classroom and simulation teaching experience in both undergraduate and graduate nursing programs. Currently, she continues to teach the undergraduate pathophysiology course at The University of Kansas School of Nursing.

Dr. Klenke-Borgmann’s educational background includes a BSN from Purdue University, an MSN from the University of Pennsylvania, with a focus in Health Leadership, and a PhD from Villanova University, with an emphasis in simulation education.

A member of the International Nursing Association of Clinical Simulation and Learning (INACSL), and a Certified Healthcare Simulation Educator (CHSE), Klenke-Borgmann brings her expertise when designing learning and research for health system professionals. Dr. Klenke-Borgmann also serves as part of the AACN Essentials Tool Kit Task Force on Clinical Judgment and is a member of the International Consortium for Outcomes of Nursing Education (ICONEd).

linkedin.com/in/laura-klenke-borgmann-phd-rn-chse-914a2a1b0

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Transcript

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Intro: 0:21

Welcome to The Sim Cafe. A podcast produced by the team at Innovative Simsolutions, edited by Shelly Houser. Join our host Deb Tauber, as she sits down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb: 0:55

Welcome to another episode of The Sim Cafe. Today. We are blessed to have Dr. Laura Klenke-Borgmann. Dr. Laura Klenke-Borgman is currently the first nurse scientist for the university of Kansas health system, where she integrates new graduate registered nurses into interprofessional sim approaches to care of the declining patient. She also conducts clinical simulation research and evidence-based practice initiatives that promote advancement and innovation of nursing practice. In this role, she also serves as a mentor to colleagues in the clinical research process. Dr. Klenke- Borgman has almost 15 years of classroom and simulation teaching experience in both undergraduate and graduate nursing programs. Currently she continues to teach the undergraduate pathophysiology course in the University of Kansas School of Nursing. She's involved with a NASCO as well as society for simulation in healthcare. Thank you very much, Dr. Clunky Borgman for being a guest today. And what would you like me to call you during this interview?

Laura: 2:02

Oh, uh, you can call me Laura, please. And I'm so happy to be here.

Deb: 2:06

Thank you so much. So I'm gonna ask my first question and I'd like to ask yes. Why don't you share with me your journey into simulation, how you got into it?

Laura: 2:18

Sure, absolutely. You know, honestly, I think when I look back, it really all started as soon as I graduated from nursing school. I, as a new grad started in a very busy level one trauma center in St. Louis, Missouri, and gonna be completely honest with you, felt pretty terrified and overwhelmed as a new graduate nurse in a really high intensity, fast paced, critical care area, like a level one trauma center. And it's then, you know, very early in my nursing career that I, I really started to think there has to be a better way. You know, there just has to be a better way to prepare nurses to make that jump from school and classroom and academics to the realities at the bedside. And that's kind of when I really became interested in education and specifically when I really became interested in simulation. And so when I became a nurse educator and began teaching, I taught in the classroom, I also was a clinical instructor, but I was also lucky enough to work and to get an assignment in the simulation lab as well. I had originally started my education career at the University of Pennsylvania at Penn. And so I, I taught in the sim lab at Penn and was like, yes, this is it. This is exactly it. This is what I, I think missed out on as a student. And I was so excited to be able to provide it to my students. And this was, I mean, this was a long time ago and back then even simulation. Isn't what it is today, but that's when I got my early start and really started to see the value in experiential learning and that contextual really getting your hands dirty aspect of learning that really allows students to see how the integration of what they're getting from school and what they're getting from the classroom can be applied at the bedside.

Deb: 4:14

You are so right. I'll never forget. My daughter, um, is a nurse and her first night shift in ICU nurse, when she realized she was out on her own, she called me and she was just so petrified. It is the most terrifying, I mean, terrifying.

Laura: 4:30

Terrifying is the word I was terrified for. I mean a long time<laugh> u m, yeah,

Deb: 4:39

A little PTSD.

Laura: 4:41

Yes,<laugh> right, exactly. That's right. Well,

Deb: 4:44

I was gonna actually have my daughter, the, uh, intensive care nurse on an episode. And she'll tell about how her experience is in simulation and then her experiences as a COVID ICU nurse at three separate hospitals, how she navigated. So, yeah. So I'm looking forward to that. Well, to get back to your story and it, and, and, you know, you find that if you would've used simulation for training in the emergency department, you would, you would've selected the right people too, if you used it for hiring decisions.

Laura: 5:20

Sure, absolutely. That's an excellent point. That's such a great point. When I graduated from nursing school, the only aspect of simulation I really had was like, just in like the deliberate practice psychomotor skills, right. Of giving an injection, putting in an IV, giving medications whenever I was in nursing school, it wasn't the case based scenarios, right. That can really build clinical judgment and clinical reasoning and prioritization skills. And that's exactly what I felt right. Whenever I got to be a new grad in the emergency room, I thought, gosh, I feel really comfortable in putting in an IV and giving medications, but why can't, why don't, I feel comfortable in making a decision and prioritizing and knowing what to do next or anticipating what to do next. And that's the beauty of SIM. And that's the value that I see as an educator now that I can provide to my students way before they graduate way before they're that terrified new grad in the emergency room, but I can provide a little bit more of that context to them through simulation based learning.

Deb: 6:26

Excellent. Excellent. And my next question is please share with our listeners your favorite or most impactful simulation story?

Laura: 6:36

Sure, absolutely. So it kind of just bleeds right into the conversation we were just having, as I became a nurse educator, I taught kind of like the med-surge course at Penn. And now here at the university of Kansas school of nursing, I teach our undergrad pathophysiology course. And in both courses for years and years at two different schools, two different sets of students, I would hear the same thing. They'd come into my office and they'd say, you know, I feel like I do really well in your class. I understand what's going on in the classroom. I enjoy your class. I do well on the exams, I'm getting the content. But then like the next day I get to clinical and we have an, you know, a patient with the same exact condition that we just talked about in class. And I feel completely unprepared. Like I just, I'm having trouble making that jump from, oh yeah, I got that right in the classroom to, oh my gosh, what do I do with it in clinical practice? And for the longest time I, I would say to students, oh yeah, yeah, yeah, yeah, yeah. That comes with time and experience. We call that clinical judgment and that comes with time and experience and kind of seeing the same types of patients over and over again that, um, you can start to see patterns and expect what's gonna happen next. Just give it time, just give it time. But after I heard this time and time again from multiple students in different schools, I thought, yeah, you know, that is true. That clinical judgment comes with time and experience, but there has to be something that I can do as their educator to help them jump and bridge that gap better from classroom to, to clinical practice, better and less painfully and make that transition. And so I started to think, you know, what can I do to help bring the clinical practice and contextualize it into the classroom? And that's where I really started to get, become really interested in the, um, use of simulation, bringing it into the classroom. And that's what I did actually for my PhD dissertation study, was to look at the effects that students in a big, large university classroom, the effects that observing simulations in the classroom has on their own clinical judgment when they themselves go participate in simulations in the SIM lab, does having that unfolding kind of simulation that contextualizes their learning that's based on the didactic stuff that we just talked about in class, does that help them bridge that gap between knowing it in the classroom and actually being able to apply it at the bedside? So I did that for my study for my dissertation and low and behold, fortunately, yes, it does. There did show to be a statistically significant effect on student's clinical judgment when they had in class Sims in the classroom. And I think to your point of like, what's my favorite or most impactful, um, simulation, I would say that these in class simulations are my favorite. I love them. I love the blending of classroom and clinical and bedside practice together. You know, we always say it's so difficult for students to contextualize learning whenever they get to the bedside and in clinical, but it's like, well, how could they, or why could they, if that's not how they're learning in the classroom? And so that's why, what I love about in classrooms is that it makes the classroom look more like clinical. And I I'll share with you one of the things that, uh, you know, we always debrief these in class Sims in the classroom. And one of the things that they, they mentioned in the feedback was, oh my gosh, we got done with this in class sim. And they were like, oh my gosh, it finally has dawned on me all of these things that I've learned for the past, let's say eight weeks in nursing school, in your class and in clinical. And in some of my other courses all just came together for me in the last 20 minutes of doing this in class SIM. And it was like, yes, yes, exactly. That's exactly why we do this, right. Is for them to see all those pieces in that puzzle for learners that can seem so disparate. Like they don't really understand that. What I'm saying in patho is going to apply to what they see in clinical, which is going to apply to what they learned about in pharmacology two weeks ago. And hearing those students have those light bulb moments because of it in class sim, it was like, yep, I rest my case, right. This is exactly why I do this.

Deb: 10:53

And I think some of our listeners might be curious about how would you do that? And to me, it's pretty simple, right? If you have oxygen delivery, so you would bring all the oxygen in and they could learn how to actually put on the cannula, not like a lasso, um,

Laura: 11:08

<laugh>

Deb: 11:10

A bag valve mask, a bamboo bag. Right, right. Remember I remember them just learning about it and the students being in a simulation and one of them saying, get the bamboo bag, get the bag, the bamboo bag!

Laura: 11:22

< laugh>

Deb: 11:24

They sing the bammoo bag, get the bamboo bag.

Laura: 11:29

Right. Yeah. And you know, that's actually a really good point. I would love to be able to do the very hands on SIM right there in the classroom. I'm really interested in that, but I will say it for the study that I did for my dissertation. And now what I continue to do in my classroom is actually a pre-recorded case. So I'll have students volunteer to be the, like, I usually get two students to volunteer a couple of days ahead of time to record a case in the SIM lab, based on a, you know, an alteration in health or a condition that we just recently talked about in the didactic portion of the class, record it. And then in the next day in class actually show it in the classroom on the big screens in the classroom. Um, and what I do is I kind of show it in this kind of like, stop start, stop, start kind of method in which we'll watch a few minutes, then we'll stop and talk and debrief. Then we'll watch a few more minutes. Then we'll stop and talk. And I give them a, a worksheet. I call it the in-class SIM observer worksheet that has specific questions that I want them to be paying attention to as they watch the case unfold, to really help them be active participants and engaged observers to really kind of be looking out for key things throughout the simulation, specifically, trying to tie clinical judgment to what they learned about, about the pathophysiology of that condition. And so that's what I'll have. I'll, I'll, we'll sort of watch a few minutes of this total. The, the cases are about 20 minutes, but I'll have them watch the first few minutes of it and pay particular attention to question number one on the worksheet, then we'll stop and debrief as a group. And then I'll say, okay, so what do you think the nurses should do next? Um, and they'll kind of decide, make a plan. And then we'll say, well, let's hit play and see what our friends did and see if they did something similar to what you came up with. And so we kind of do this kind of methodology to really help them be active and feel like they're kind of living vicariously if you will, through the, the recording itself.

Deb: 13:27

Excellent, excellent. That, uh, I think a lot of our listeners are gonna learn something from that, that they might want to, you know, incorporate into their program. Thank you.

Laura: 13:36

Yeah, absolutely.

Deb: 13:38

Now my next question is Laura, where do you see the future of simulation going? What's what kind of goes through your head and mind on a question like that?

Laura: 13:47

Yeah, that's a great question. I love that question. I think honestly, with simulation, the sky is truly the limit. I think it's only bordered by the limits of people's own creativity. I think, especially with the evolving approaches and methods of virtual reality and augmented reality and all of the like huge doors that, that opens for us. I think that there's so much value in the innovative creative ideas that people have around that specifically for really to use those kind of new evolving, innovative methodologies to tackle the really big issues that currently in specifically like in nursing to really tackle those huge problems that we currently have, like kind of what I was mentioning, right? The lack of clinical judgment that we know our new grad nurses graduate with that transition to practice gap that we know is there, that academic practice gap. And I think that's where we're gonna start seeing the future of simulation is trying to truly because of people's innovation and creativity, fill those really big, important gaps right now in education.

Deb: 15:00

Thank you. Thank you. Now, did you guys anything, any special lessons from the global pandemic that you learned at your school that you can share with our guests?

Laura: 15:11

I think for me, the, one of the biggest things that really became apparent to me is the value of screen based simulation virtual simulations, to be honest with you. Um, I had never done any screen based virtual simulations before COVID and I became very familiar with them throughout the pandemic in providing learning opportunities to our students. And now, even that we're sort of in slash post slash who knows right of this pandemic, I'm still very interested in the value of virtual simulation screen based simulation. In fact, in my neuro scientist role that I have in the health system, I actually am participating in a virtual simulation study right now with our new grad residency program in our hospital and how virtual simulation assists new grads in specifically like delegation prioritization, patient management types of skills. And so I think, you know, that showed me right there. There's so much value in that, that I don't know that I would've learned that lesson, had it not been because of COVID and having to switch to screen.

Deb: 16:12

Right. No, you're a hundred percent. Right. And I think in, in your comment, as far as AI VR, all those different technologies that are coming into play, I think the thing that we really need to make sure that we're doing is being very mindful and deliberate in selection of things, because we have different people who have, you know, like gamers and who don't yeah. Aspects of healthcare as much as many of us do. And I remember the integration of electronic medical records into the hospital and it was, you know, it wasn't thought through very well. Yeah. Get everyone together at the table. And I is a healthcare community, a simulationist community. We need to be working together to make sure that we, you know, select the best products for, you know, learning

Laura: 17:00

Yeah, absolutely best products. And as you mentioned, just being really deliberate and intentional about what gaps or what problems that those products in those particular types of learning experiences will fill. Do we have to be really, really deliberate and thoughtful about that. Especially given current climate and healthcare and staffing shortages and things like that. We have to be really deliberate that what we're doing is going to be really impactful because people don't have a lot of time to spend if they don't

Deb: 17:30

And then we'll have people that'll get grant money and they'll yeah. Spend it on something, you know? So I think us being forefront leaders on, on those decisions is gonna be paramount.

Laura: 17:43

Oh yeah. Huge. Definitely. And I we're definitely, at that point, I feel like we're at a big pivotal point with that right now.

Deb: 17:49

Yeah. I would agree. I would agree. I do wanna ask you one more question. Now you're a nurse scientist and, and I had another, a couple other people who are nurse scientists. And to be very honest with you, I don't really know what that means. So I'm gonna ask you that question. Sure. I imagine that probably there might be a guest out there that's like, yeah. I know. Know what it is either.

Laura: 18:08

Yeah.<laugh>, that's a great question. Um, in my role as a nurse scientist for the health system of the university of Kansas, I really work in asking questions and finding database answers, evidence based answers to them. So basically I'm a nurse researcher for the health system. And my background in simulation and my background in education has led me to be curious, has led me to want to ask questions about problems or gaps or barriers that I see. And I feel like becoming a nurse scientist has been just kind of a very natural, authentic evolution for me is that after all of my years, as a simulationist as, and as an educator, I have a lot of questions, right.<laugh> I mean, I have a lot of questions that I wanna know more about. Does this strategy work, does that strategy help the transition to practice go better? How can simulation affect the quality and safety of the care that nurses are giving at the bedside? Right. I mean, I just have lists and lists and lists of, of questions. One of the things I'm really passionate and interested in is, is indeed how we develop the way that nurses think. And so a nurse scientist basically is a nurse researcher who asks those really big, important questions that will impact patient outcomes that will impact care that nurses give and then conduct research studies and evidence based projects to answer those questions and to affect change and to essentially affect the way that care is given. And that the ultimate is to have it affect patient outcomes. Does that help? Does that make sense and answer your question?

Deb: 19:51

It makes complete sense. And it's, um, it, what I'm hearing you say is you found your true North.

Laura: 19:57

I did<laugh> I did. I feel like, you know, looking back in hindsight from those terrified days in the emergency room as a new grad, right. I look back and yes, there were a lot of hiccups in the road and there were a lot of times in my career that I'm like, what am I doing? But in hindsight, I look back and it all has made a logical progression and it all has sort of made sense to get to the point where I am now to ask these questions and to hopefully find some answers to them.

Deb: 20:26

Excellent. Excellent. The final question I'm gonna ask you is if our listeners wanna get ahold of you, where can they get ahold of you if they have questions from a research perspective, because you have a, a lot of knowledge, a lot of knowledge, and, um, people might wanna ask some questions or get some information from you or get some informatrion from you.

Laura: 20:46

Absolutely. Or collaborate, or to ask these big questions and answer them together in Information from you, research projects. Absolutely. They can get ahold of me by my email. My email, uh, for at KU is just LKlenkeBorgman, my last name,@KUNC.edu. I'm also pretty active on LinkedIn. So you can certainly find me on there as well, but yeah, absolutely reach out. I'm always happy to talk and chat. And, um, like I said, ask questions and try to figure things out.<laugh>

Deb: 21:18

Right. Yes. All right. Well, thank you very much for this interview and happy simulating.

Laura: 21:24

Thank you, Deb.

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Outro: 21:38

Thanks for joining us here at The Sim Cafe. We hope you enjoyed. Connect with us at www.innovativesimsolutions.com and be sure to hit that like and subscribe button. So you never miss an episode of The Sim Cafe.