Class of 2022: In hospitals, quick and accurate thinking is key. Jessica Mulli helps aspiring nurses to learn the skill

Jessica Mulli completed her thesis-based Master of Nursing program this spring while balancing her duties as an instructor with the Faculty of Nursing. While teaching in clinical settings, she noticed how student reflection resulted in deeper learning and decided to explore the topic further in her thesis.

Her research focused on reflection in action during high-fidelity simulation for which she published two papers; one even appeared in a high-impact open-access nursing education journal. Mulli was also the recipient of the WNRCASN 2021 Graduate Student Research Grant, which funded her studies. She successfully completed her defence last October. 

“Jessica’s research has the potential to inform best practice for simulation design, training, facilitation and debriefing," says Dr. Lorelli Nowell, PhD, Mulli’s grad supervisor and assistant professor with nursing. "The findings from her research study will be used to create guidelines for simulation facilitators and improve student learning within simulation.”

Mulli is currently a contributing member of CAN-Sim (Canadian Alliance of Nurse Educators Using Simulation), which already uses her papers as resources. They are also required reading for the Canadian Association of Schools of Nursing (CASN) Canadian simulation nurse educator certification and her findings have already been adopted into the sim programs at UCalgary and MacEwan University in Edmonton.

What made you first decide to become a nurse?

Prior to nursing, I did development work in different countries like Kenya and Rwanda. When I was in Rwanda, we were opening an orphanage and there was one nurse and 50 children doing medical welfare checkups on all the kids before they came into the orphanage. I was asked for assistance with documentation as that is a lot of children to assess. She dictated her charting to me while doing her assessments.

I decided to be a nurse after this. You could see how needed the nurses are and how much they can do for people. That is why I did my postgraduate certificate in neonatal nursing and worked NICU [newborn intensive care unit] and paediatrics because those are areas of great health. I came back and applied to nursing school [Mulli did her BN at Mount Royal University]. I graduated and started working in the Level 3 NICU at the Alberta Children's Hospital, and I did my advanced studies in a perinatal and neonatal nursing certificate. Then I went to Haiti where I was working in a hospital in the NICU.

What problem are you trying to solve through your research?

How can we be better educators and support students to learn. Because we're nurses, we're not teachers and, if we are teaching, we must learn how to teach. Reflection-in-action is the hallmark that you've mastered a subject and that you understand a subject, and it takes place when there's like a surprise or a challenge. Say you’re doing your patient assessment and, suddenly, something is wrong. A master of a subject will identify that that change has happened and be able to intervene immediately, make a change in their plan and continue. A learner, however, may be able to identify that's something's wrong but they won't be able to immediately take the next steps or change their plan of action.

Why, and how, is this important to individuals/society?

What I wanted to do is help nursing instructors know how to support learning and thinking in the moment and identify that for students afterwards. When you do these strategies to help people reflect-in-action, students feel proud and accomplished and confident in themselves. All they really needed is that time; so giving them the time to think things through and succeed builds that confidence and that helps with patient safety and improved patient outcomes.

What inspired you?

At the time, we were running a very challenging simulation for Term 6 students. It was one that I wrote and developed on paediatric sepsis and shock. Students didn't know how to respond because they had never experienced it before. Dave Patterson [another UCalgary Nursing instructor] had been sharing articles with me. And he handed me an article on the facilitated pause.

Basically, their hypothesis was about how students could come to their own conclusions if instructors just pause their simulations. Typically, you're not supposed to break out of or pause the simulation. But I had just read this article and so I experimented with it. When the students got stuck, I'd say, "Hey, take a time out." They talked about their assessment findings and what the next steps were; amazingly, every single group was then successful. But, without the facilitated pause, they weren't.

What was your approach?

Most of the research out there is on debriefing, which is reflection-on-action. Debriefing is the retrospective process where you look at what happened in simulation in the decisions you made and why. Often, a lot of people will say it doesn't matter what happens in sim, you can succeed or fail, we’ll debrief about it, but my argument is, if simulation is for learning, why would we let students fail? Let's help them succeed and think through this correctly so that, when we debrief, the debriefing is different. In clinical, we would never let a student do something wrong with a real patient. So why do we let them do something wrong in simulation?

How did UCalgary support you?

During my master’s program, I had support from my colleagues who would hand me papers to read and give me ideas and people would proofread my papers. I also learned how to use my resources effectively, like the Student Success Centre. But having a good supervisor I think is one of the most important things in being successful. At the beginning of each semester. Dr. Nowell would sit down with me and we'd look at the course outline and how I could make the assignments in the course fit my thesis so that all the work I did was focused on the research.

Where to from here?

I just started a new job with the community nursing branch with the Yukon Government. I am their new manager of clinical practice and quality improvement. The way the services are split is that there's Yukon Hospital Corporation, which deals with the hospitals. There are only three hospitals in the Yukon: one in Whitehorse, one in Watson Lake and one in Dawson City. The Yukon has a lot of small community health centres that service the communities with nursing stations. The Community Nursing Branch of the Yukon Government oversees these. The registered nurses are the ones who provide the primary care and emergency care in these smaller communities. I will be overseeing the education for the 11 nursing stations and be monitoring best practices and implementing quality-assurance measures. One of the first things I’ll be doing is reinvigorating the orientation for new hires and the annual education for the nursing staff through designing a simulation program.