Student Instructions for Standardized Simulation NR 452 Eric Chilton PURPOSE The following information is to be used in guiding your preparation and participation in the scenario for this course. This document will provide applicable course outcomes in preparation for your simulation. SCENARIO OVERVIEW Eric Chilton is a 62 yo male who just arrived to the floor from PACU who had a right knee arthroplasty. He was administered Morphine Sulfate 10 mg IVP in the PACU prior to coming to floor. Currently, he is on a Morphine Sulfate PCA pump and family members are at bedside. Family members are worried about his pain level. The scenario takes place on Tuesday at 1200. STUDENT ROLES DURING SIMULATION: During pre-briefing, you will be assigned one of these roles according to the description below to participate in the simulation as a nurse. Charge Nurse (Registered Nurse) (1): The charge nurse is responsible for the overall organization of safe, quality client care. You are the team leader and serve as a resource to all interdisciplinary members and are responsible for appropriate delegation of duties. You will serve as the point person for communication and can anticipate speaking with the physician or other primary care provider, ancillary support services, and others directly involved with the care being provided. You must be knowledgeable about the client s condition and able to dictate orders obtained and assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs. Documentation Nurse (1): The documentation nurse is responsible for recording of all patient event activities during the simulation with the exception of medication administration. You are responsible for documenting within SimChart assessments, interventions, and outcomes on the designated tool (paper or electronic). Be prepared to read back and verify your documentation when requested and/or clarifying the details. Additionally, you will be part of the interdisciplinary team and will contribute observational assessment findings to include but not limited to changes in vital signs, alerts, psychosocial needs, and anticipated care. NR 452 Eric Chilton Student Instructions Revised 12.14.16 1
Assessment Nurse (1): The assessment nurse is responsible for overseeing a comprehensive assessment of the patient. This includes but is not limited to obtaining vital signs, head-to-toe assessment of all systems, and psych/social assessment of the patient. You will be prioritizing care, executing independent interventions, collaborating with interdisciplinary team members, anticipating the needs of the patient/family, and re-assessing or continually monitoring the patient for any changes in condition. You are responsible for implementing all non-medication related interventions, verbalizing your findings to the team, and recommending any actions/interventions required. Additionally, you will be providing appropriate education to the patient and family/significant others. Medication Nurse (1): The medication nurse is responsible for all actions and documentation related to safe administration of medications. You will identify and correct any medication errors related to prescribing or distribution. This may include speaking with the physician or primary care provider. Prior to administering medication, you will assure the Rights of Medication Administration. You must be knowledgeable regarding the action and expected effects of the medications being administered and are responsible for monitoring and reporting any adverse reactions or unforeseen consequences of administration. Part of your role includes verifying medication calculations with a colleague and identifying any incompatible drug combinations. Observer Nurse: The observer is a non-participant role and will not communicate directly with the simulation team. The observer nurse will view the simulation in the briefing room through Learning Space as it is occurring. There may be multiple observer nurses in each scenario. The observer nurse will be given an observation guide to complete during the simulation. The data you collect will help the team during the debriefing process and facilitate an open and active discussion regarding the simulation experience. You will be an active participant in the debriefing and will be encouraged to share your observations and thoughts. Please keep in mind that your observations should be conveyed in a respectful, educational manner. The goal is to work together as colleagues in providing safe and effective care. COURSE OUTCOMES The NR452 Standardized Simulation enables the student to meet the following priority course outcomes: CO 2. Integrate communication and relationship skills in teamwork and collaboration functioning effectively with health team members and consumers of care (PO 3) NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 2
CO 3. Utilize information technology to manage knowledge, mitigate error, and support decision making with health team members and consumers of care (PO 2) CO 4. Integrate critical thinking, clinical reasoning skills, best current evidence, clinical expertise, and patient/family preferences/values in the implementation of the nursing process (PO 4) **Although this scenario can address multiple course outcomes, faculty and students should focus on the course outcomes listed above** DUE DATE: The standardized simulation should be performed anytime during Units/Weeks 1-8 to ensure students are prepared to meet the objectives. This scenario consists of two clients for a multi-client standardized simulation. SIMULATION TIMING Pre-brief: 20-30 minutes Run Time: 30 minutes Debrief: 60 minutes REVIEW AND COMPLETE PRIOR TO THE START OF PRE- BRIEFING In order to prepare for the simulation, you should complete the assigned reading for the course. In addition, you should be prepared to complete and document a thorough nursing assessment along with completing the following skills: Prioritization and Delegation Effective Communication Post-Operative Assessment Opioid/Narcotic administration considerations Cardiac Rhythm Identification Please keep in the mind the students will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills. Therefore, in order to prepare for the simulation, please review the Nurse Practice Act and Skill Sets below prior to the simulation. NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 3
You are required to complete the pre-briefing questions below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation. 1. What standard precautions should be implemented for the post-operative administration of opioid medications? 2. What are common post-operative complications after general anesthesia and orthopedic procedures? 3. What are nursing primary considerations when performing a post-operative nursing assessment? **Immediately following the completion of debriefing, you will complete the evaluation of the simulation within Learning Space** NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 4
The Nurse Practice Act and Professional Skills Set The Nurse Practice Act (NPA) was enacted by the legislature of each state to protect patients safety and to guide the scope of practice for all levels of nurses. Any change in the scope of nursing practice will be updated in the NPA. DEFINITION OF NURSE PRACTICE ACT (NPA) The NPA represents all laws that regulate a nurse s scope of practice in the state or states of America in which she (or he) is licensed to work. These laws protect patients from harm as well as lay the rules and regulations for the specific level of a nurse s educational and licensure requirements. FUNCTION Provides professional regulation in protecting patient safety and rights and it establishes standards and codes of ethics for practitioners at different levels of expertise. STATE REQUIREMENTS Each state in America has an NPA that is enacted by the state legislature that delineates the scope of proper nursing practice in that jurisdiction. This scope may vary from state to state so it is important for nurses to familiarize themselves with the rules and regulations of the state or states in which they are licensed to practice. Traveling nurses and those in the process of relocating to a different state need to pay particular attention to the local NPA. SCOPE OF PRACTICE The scope of practice is different for each field and is determined by specific educational requirements and licensure applicable to each job title and covers procedures and patient care practices limited to the specific titles. INDIVIDUAL PROFESSIONAL RESPONSIBILITY It is important for health care professionals to take the responsibility to keep abreast of the changes and developments inherent in remaining a safe patient care provider. They need to rely on the resources of professional organizations and information found in professional journals in conjunction with the standards of practice of each employer and the continuing educational unit requirements as their guides in this. Nurses need to perform the duties for which they have received specific training. Most importantly, each needs to be familiar with the stipulations of her (or his) Nurse Practice Act. The Nurse Practice Act and Professional Skills Set DEFINITION OF REGISTERED NURSE (RN) A graduate nurse trained in the scientific basis of nursing to provide services that are essential to or helpful in the promotion, maintenance and restoration of health and well-being of individuals. The graduate nurse meets certain prescribed standards of education and clinical competence and is registered and licensed to practice by a State Board of Nursing or other state authority. NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 5
SCOPE OF PRACTICE Direct and indirect patient care services that ensure the safety, comfort, personal hygiene and protection of patient; and the performance of disease prevention and restorative measures The performance of skin tests, immunization techniques and the withdrawal of blood from veins and arteries Observation of signs and symptoms of illness, reactions to treatment, general behavior or general physical condition and determining of whether the signs, symptoms, reaction, behaviors or general appearance exhibit abnormal characteristics. Implementation of interventions based on observed abnormalities and appropriate reporting, or referral of changes in treatment regimen or the initiation of emergency procedures if necessary. The comprehensive nursing assessment of the health status of patients that addresses changes to patient conditions The development of a plan of nursing care to be integrated within the patient-centered health care plan that establishes nursing diagnoses and setting goals to meet identified health care needs, determining nursing interventions and implementation of nursing care through the execution of nursing strategies and regimens ordered or prescribed by authorized healthcare professionals The administration of medication or delegation of medication administration to licensed practical nurses Delegation of nursing interventions to implement the plan of care The provision for the maintenance of safe and effective nursing care rendered directly or through delegation Advocating for patients The evaluation of responses to interventions and the effectiveness of the plan of care Communicating and collaborating with other health care professionals The procurement and application of new knowledge and technologies The provision of health education and counseling Participating in development of policies, procedures and systems to support patient safety The Nurse Practice Act and Professional Skills Set DEFINITION OF LICENSED PRACTICAL NURSE (LPN) NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 6
A graduate of a school of practical nursing whose qualifications have been examined by a state board of nursing and who has been legally authorized to practice as a licensed practical nurse. According to the role definition proposed as a model by the American Nurses Association, the definition of L.P.N. practice has been updated to include the performance under the supervision of a registered nurse of those services required in observing and caring for the ill, injured or infirm, in promoting preventive measures in community health, in acting to safeguard life and health, in administering treatment and medication prescribed by a physician or dentist or in performing other acts not requiring the skill, judgment and knowledge of a registered nurse. SCOPE OF PRACTICE Direct and indirect patient care services under the supervision of a registered nurse (RN) that ensure the safety, comfort, personal hygiene and protection of patient; and the performance of disease prevention and restorative measures Medication administration Data collection on patients and contributions to the care plan Monitoring for changes in condition Vital sign checks, wound care and dressing changes, specimen collection, urinary catheter insertion and care, care of patients with ventilators and tracheostomies, ostomy site care and maintenance, CPR and finger stick blood sugar testing Documentation of nursing care Reinforcement of patient education Follow up assessment of patient conditions NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 7
OUTSIDE OF THE LPN SCOPE OF PRACTICE Cannot do initial assessments of patient condition and complaints Cannot interpret patient clinical data or act independently on such data Cannot triage Cannot create, initiate or alter nursing goals or establish nursing care plans Cannot do initial patient education regarding patient condition, surgeries or complaints Cannot administer IV chemotherapy Cannot administer any direct IV fluid bolus or push medications except for saline and heparin flushes The LPN is a nurse with limitations and restrictions compared to the Registered Nurse NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 8
The Nurse Practice Act and Professional Skills Set DEFINITION OF UNLICENSED ASSISTIVE PERSONNEL (UAP) Healthcare workers who are not licensed but provide non-nursing custodial, health-related activities and/or clerical patient care services under the supervision of a registered nurse. Unlicensed assistive personnel include patient care technicians, nurses aides, certified nursing assistants and unit secretaries. Non-nursing functions are generally classified as housekeeping, clerical, transportation and dietary tasks. Health-related activities are direct patient care activities that are not within the legally protected scope of nursing practice and can be assigned to UAPs who have demonstrated competency. A health-related activity is one that does not require professional judgment or critical thinking. SCOPE OF PRACTICE OUTSIDE OF THE UAP SCOPE OF PRACTICE Activities of Daily Living (ADL s) such as feeding, bathing, ambulating, turning and positioning, grooming, toileting, oral care, etc. Vital signs Measuring basic intake and output With additional training and demonstrated competency, UAPs may also be permitted to: Taking EKGs Obtaining blood glucose levels using a glucometer Performing phlebotomy FIVE RIGHTS OF DELEGATION The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is: 1. The right task 2. Under the right circumstances 3. To the right person 4. With the right directions and communication; and 5. Under the right supervision and evaluation NR 452 Eric Chilton Simulation Student Instructions Revised 12/14/16 9