Simulation Design Template

Transcription

1 Simulation Design Template Date: May 7/8, 2008 File Name: Discipline: RN, Charge nurse, medical radiology, pharmacy tech, social work, medicine (whatever is available at the institution) Student Level: First year/semester Expected Simulation Run Time: 15 minutes Guided Reflection Time: 20 minutes Location: Pediatric Unit Location for Reflection: Debriefing Room Admission Date: Today s Date: Brief Description of Client Name: Kate Gender: F Age: 2 months Race: Caucasian Psychomotor Skills Required Prior to Simulation: respiratory assessment; CV assessment/inspection; vital signs; assessment and interviewing skills; safety aspects (check armbands) Weight: _10 kg Religion: Atheist Phone: Height: _60_cm Major Support: Mother and Father Allergies: Unknown Immunizations: Up to date Attending Physician/Team: Dr. McDreamy Past Medical History: Vaginal birth, delivered 37 weeks, no known complications, breast feeding, well until today, weight and growth gain within normal range History of Present illness: well up until today; Mother noticed that during breast feeding there were periods of apnea; admitted for observation Cognitive Activities Required prior to Simulation [i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]: SBAR reading material (interprofessional way of data organizing - R); developmental levels of a two month old (L); understand immunization requirements R and L; review vital signs for the age group R and L; head to toe assessment V; Social History: Both parents are smokers; first child Primary Medical Diagnosis: respiratory distress; cause unknown Surgeries/Procedures & Dates: None to date

2 Simulation Learning Objectives 1. Communication with family (therapeutic, client based) 2. Professional communication amongst the team 3. Recognition of the abnormality (skill set of assessment, critical thinking, who to call, when to call) 4. Seeking appropriate guidance in a timely manner

3 Fidelity (choose all that apply to this simulation highlighted in red) Medications and Fluids o IV Fluids: Setting/Environment o ER o Med-Surg o Peds o ICU o OR / PACU o Women s Center o Behavioral Health o Home Health o Pre-Hospital o Other o Oral Meds: o IVPB: o IV Push: o IM or SC: Simulator Manikin/s Needed: infant and crib Props: stethoscope, alcohol wipes, hand wash, baby blanket Equipment attached to manikin: o IV tubing with primary line fluids running at cc/hr o Secondary IV line running at _ cc/hr o IV pump o Foley catheter cc output o PCA pump running o IVPB with running at cc/hr o 02 o Monitor attached o ID band o Other Equipment available in room o Bedpan/Urinal o Foley kit o Straight Catheter Kit o Incentive Spirometer o Fluids o IV start kit o IV tubing o IVPB Tubing o IV Pump o Feeding Pump o Pressure Bag o 02 delivery device (infant) o Crash cart with airway devices and emergency medications o Defibrillator/Pacer o Suction o Other_ID band for parents Diagnostics Available o Labs o X-rays (Images) o 12-Lead EKG o Other Documentation Forms o Physician Orders o Admit Orders o Flow sheet (to monitor apnea episodes) o Medication Administration Record o Kardex o Graphic Record o Shift Assessment o Triage Forms o Code Record o Anesthesia / PACU Record o Standing (Protocol) Orders o Transfer Orders o Other Recommended Mode for Simulation (i.e. manual, programmed, etc.) Programmed

4 Roles / Guidelines for Roles o Primary Nurse o Secondary Nurse o Clinical Instructor o Family Member #1 o Family Member #2 o Observer/s o Recorder o Physician / Advanced Practice Nurse o Respiratory Therapy o Anesthesia o Pharmacy o Lab o Imaging o Social Services o Clergy o Unlicensed Assistive Personnel o Code Team o Other _can be role for whoever is at institution Important Information Related to Roles - One nurse to deal with family, one with situation - Mother usually consulted, father usually ignored - Interprofessional team on standby until they are called in, without knowing what is going on until they enter - 8 minute into evaluation, there will be an episode - If no one calls by ten minutes, parents get hysterical - SBAR as a communication tool Student Information Needed Prior to Scenario: o Has been oriented to simulator o Understands guidelines /expectations for scenario o Has accomplished all pre-simulation requirements o All participants understand their assigned roles o Has been given time frame expectations o Other Report Students Will Receive Before Simulation Baby Kate and family have just come from emerg, parents brought her in, concerns she turned blue; facilitator will give emerg report, responsibility is to go in and do assessment; reporting nurse will read over the orders Time: before simulation time, outside of simulation room; approximately two minutes Significant Lab Values All normal from emergency Physician Orders -Admit for respiratory distress -Neuro consult -Apnea monitor -Vital signs x 24 hours, breast feeding on demand -O2 sats greater than 92%, monitor apnea episodes, call MD if apnea is greater than 30 seconds or associated with bradycardia or greater than 3 in an hour - portable chest x-ray on arrival to unit - MRSA and VRE swabs as pre protocol

5 References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For This Scenario: (site source, author, year, and page) - Health assessment text and lecture - Therapeutic nurse-client relationship standards - SBAR - Any relevant professional standards related to therapeutic-client relationships; anything related to interprofessional communication

6 Timing (approximate) Scenario Progression Outline Manikin Actions Expected Interventions May Use the Following Cues 0-8 minutes SIM infant will be breathing; respiratory rate of 40; heart rate of approximately 130 Introduce self, contract (permission to touch, identifying what will happen), take vital signs, head to toe assessment key indicators inspection/oscilltation of chest Student 1 Cue: N/A 0-8 minutes SIM infant will be breathing; respiratory rate of 40; heart rate of approximately Minutes Stops breathing for 30 seconds; being breathing again after 30 9 minutes (if not caught) If caught the first time at 9 minutes minutes Breathing Continue to breathe at regular rate Introduce self, contract; gathering history Nurse 1 or 2 observes event, times it, records it, reports it If event not observed, parent will react Nurse 1 or 2 respond to cue and time apnea and report, put O2 on, record, call for help (delegate) Call medical response team (MRT) Nurse 1 gives SBAR report to team while still in team Nurse 2 observes baby Documentation Physician can begin assessment Speak to parents Student 2 Cue: N/A Cue: Father Cue: there it goes again, that s the second time if missed the first time Cue: Cue:

7 Debriefing / Guided Reflection Questions for This Simulation (Remember to identify important concepts or curricular threads that are specific to your program) 1. How did you feel throughout the simulation experience? 2. Describe the objectives you were able to achieve? 3. Which ones were you unable to achieve (if any)? 4. Did you have the knowledge and skills to meet objectives? 5. Were you satisfied with your ability to work through the simulation? 6. To Observer: Could the nurses have handled any aspects of the simulation differently? 7. If you were able to do this again, how could you have handled the situation differently? 8. What did the group do well? 9. What did the team feel was the primary nursing diagnosis? 10. What were the key assessments and interventions? 11. Is there anything else you would like to discuss? Complexity Simple to Complex Suggestions for Changing the Complexity of This Scenario to Adapt to Different Levels of Learners