Innovation in nursing aims to create and shape the future of the nursing profession to prepare nurses to changing yet challenging environments and practices. Action Learning using simulation is one such innovative strategy involving the replication of reality to draw on reflection.

Innovation in nursing aims to create and shape the future of the nursing profession to prepare nurses to changing yet challenging environments and practices. Action Learning using simulation is one such innovative strategy involving the replication of reality to draw on reflection. The purpose of this innovation is aimed to review the utilization of reflection using Action Learning (AL) and simulation involving the workplace team based on an experiential learning framework post analysis of the learners learning styles.

Kolb (1984) describes experiential learning as the process where knowledge is created through the transformation of experience. It offers the learner a hands-on experience to a collaborative and reflective learning event whilst new knowledge and skills are developed (Haynes 2007). As the learner creates thought into new ideas through reflection this new idea will be tested in the new setting resulting in the learner making new decisions leading to new actions being applied improving their practices.

McGill and Beaty (2001) further elaborate on Kolbs learning cycle stating that it is the reflection on an experience which is crucial to apply to new situations with Rogers (2002 p849) describing reflection as increasing critical thinking skills which will in turn effect future actions and learning in the workplace resulting in advanced professional practices. This reiterates our purpose of reflection using an AL approach as reflections should inspire improved future actions.

Honey and Mumfords (1986) experiential learning pathway further collaborates the use of simulation addresses all four learning styles thus proving its appropriateness in this AL project through the utilisation of reflection especially during the debriefing stages. The Activist will perform tasks enduring an experience Concrete Experience; The reflector observes and reflects -Reflective Observation; Theorists aim to comprehend underpinning rationales concepts and meaning Abstract conceptualisation; whilst pragmatists are proactive in having a go being experiential Active Experimentation. This validates our purpose using an experiential learning approach for an AL within a simulated environment allowing learners to attempt skills understand concepts whilst reflecting on practices in a safe creative environment.

Musolino & Mostrom (2005 p63) assert the need for health care workers to continue to reflect upon how to resolve specific issues in order to perform competent practices thus exposure to past experiences is pertinent in shaping the creation of new actions.

AL is Learning from concrete experience and critical reflection on the experience through group discussion trial and error discovery and learning from and with each other (Zuber-Skerritt 2002 p.114-115). Lifelong learning promotes a connection between reflection and action attempting to learn from experiences relating to real work issues. Staff through AL will reflect on the simulated scenarios in this task to implement reflection from experiences to endorse group feedback to plan the next action collaboratively.

Simulation is techniques used to represent nursing processes and actions in an educational context (Schiavenato 2009 p. 389). Re-enacting the role of the nurse or even a patient in a simulation setting may allow for complex procedural skills or intrapersonal skills to be demonstrated and reflected upon. Whilst it facilitates a re-enactment of crucial aspects within the workplace it allows the learners to evaluate different methods assess different approaches experience range of outcomes and develop underpinning key issues observed to implement in the next action encountered.

Interestingly Kaakinen and Arwood (2009 p2) in their review of 104 nursing simulation literature concluded that most literature referred to the use of simulation as a learning tool without the inclusion of adult learning theory in the simulation designs. They suggest that Kolbs theory on experiential learning should be utilised in simulation designs to engage learners using their identified learning styles i.e. auditory kinaesthetic visual or social learners. Thus learner pre-assessment is crucial to tailor simulations accordingly.

Nursing education literature validates simulation being evolved and now a common clinical learning tool. The use of debriefing brings forth the notion of reflection also. Gordon and Buckley (2009 p492) discuss the benefits of simulation training for nurses within an experiential learning approach by identifying improvement in both technical and non-technical patient management skills whilst augmenting learning and developing clinical expertise. To elaborate on this further then promotion of a positive learning environment amongst staff may facilitate a voluntary learning atmosphere allowing learners to engage within an effective workplace environment and the AL proposed.

The Medical High Dependency Unit located at Westmead Hospital Sydney is a 16 bed unit catering for patients who are critically ill requiring delivery of advanced nursing cares within a fast paced stressful environment. The staff ratio of seniors to juniors is estimated at 1:3 respectively with New Graduate nurses who have completed the Transition to Practice Program within the previous year progressing into the intermediate level within the unit skill tree. If all staff are able to understand their peers learning styles then perhaps experiences will lead to reflective practices resulting in new transferable AL skills becoming embedded into the ward culture.

12 staff were originally agreed to participate using the AL approach; three senior Registered Nurses three intermediate level Registered Nurses three New Graduate nurses a dietician a medial officer the unit manager. Only 7 members within the multidisciplinary team chose to proceed due to rostering issues. Staff was unfortunately not permitted study leave. Negotiation with the manager however resulted with staff permitted to utilize work time to meet twice a week between the shift changeover times of 1400 to 1530 hours on the allocated days. Some staff committed on their days off to participate:

Introductory Session One:Staff will be given orientation to the expectations and purpose of the sessions
Planning and structure of the AL to take place to be discussed
Staff will be provided background information through PowerPoint and YouTube videos handouts and internet websites and literature in addressing fundamental components for this project and self directed learning
Areas to cover include:
Introduction to AL
Introduction to the Experiential Learning Approach
Learning styles aimed to assist staff in identifying their own learning styles This will later impact on the group designs to address appropriate learning styles with appropriate pairing of staff based on their learning styles
Simulation including debriefing
Reflection processes
Conclusion of session one
Introductory Session Two:Recap of session one
Vision for the workplace will be discussed with commitment to feedback to the larger group through videotaping development of a private YouTube channel method for feedback to the unit
Identification of issues learners felt they were able to influence
Reflecting on issues relating to clinical practices
Reflection teaching methodologies such as journaling portfolio development concept mapping and simulation
Devise simulation scenarios from the issues identified for the AL project This will be videotaped and uploaded to the unit YouTube channel for staff not actively participating to remain informed and updated
Conclude session with a post survey
Introductory Session Three:Recap of session two
Experimenting with AL to implement on identified issue from session two
Engage with inclusive teaching strategies Use of integrated learning such as flip charts and LCD projectors to record and present ideas in real- time. Create a safe comfortable environment for learning Encourage active participation through facilitation not teaching Allow staff to lead sessions Encourage effective collaborative learning and communication Keep it meaningful and relevant Foster a sense of competence including feedback Provide support whilst promoting learners ownership of the tasks Content remains relevant to the learners and purpose
Possible issues encountered:Anxiety and fear Part of the learning process and cannot be fully alleviated it is not about performing but rather allowing for possibilities in a controlled environment to assist in the reflective process

Making connections Allow for simulation topics to be closely linked to the reality of the workplace to make the connection with simulation and clinical experiences and even colleagues

Debriefing Constructive feedback in smaller groups may enhance simulation benefits and minimize anxiety related to an open disclosure of their reflection should also occur immediately after simulation sessions to collaboratively discuss scenario and decisions made

Fidelity Use of high and low fidelity manikins and actors to incorporate realism of simulation environment depending on learners involved

Learning Facilitate learning by observing others debriefing and listening and discussing possible approaches and perspectives through reflection

Managerial Support Reiterate AL as a positive transformation of workplace culture to improve the unit through empowerment

AL Underpinning knowledge lacking thus unable to understand true impact in workplace; sessions perceived to be negative and challenging; learning to listen to understand and respect individuals perspectives and experiences is crucial to AL. Will need to support through examples of AL and how it will positively affect them