Nursing Simulation Curriculum

Development ProjectRieneke Holman, PhD, RN & Rachel Ardern, HlthScD, RN

George and Beth Lowe Innovative Teaching GrantFaculty Survey Needs Assessment

of Missing Student Clinical Experiences Needed in Simulation

Table 1

Maternity (pre-eclampsia, well-delivery,

placental abruption.c/section, infant resusc &

assessment)

XXXXXXXX

Pediatrics (RSV, meningitis, seizure, assessment,

DKA, newborn)

XXXXXXXXXXXXXX

Psych/Mental Health/substance abuse (de-

escalation)

XXXXXX

Community X

Out-patient/Clinic X

Skills (Foley placement, NG tube placement,

chest tubes, JP drains, hemovacs, wound vac,

central line dressing changes, blood admin,

ventilator, art-lines. PAC’s, trach, abnormal lung

sounds, injections)

XXXXXXXXXXX

Cardiac/STEMI/Post CABG XXXX

GI bleed X

Oncology X

Pulmonary edema (meds, labs, PVC’s) X

Code/ED XXXXXXXXXX

Post-mortem care/Death & dying XX

Taking multiple patients XXX

Communication/collaboration

(phone/text/email)

XX

Validating/handling difficult patients/family

members

XX

Diabetes management/teaching/DKA XX

Policies/procedures X

Alternative pain management X

Shock/sepsis XXXXX

Prioritization X

Delegation XX

Leadership X

Clinical judgement X

ICU X

Giving and receiving SBAR reports X

Admissions X

Documentation X

Burns X

TBI/ICP monitoring XXXX

Ethical dilemma/challenge to professionalism X

Difficult topics/conversations with patients X

Reaction to blood transfusion X

Sim Scenario Content by Semester

Sim 1

(weeks 4-5)

Sim 2

(weeks 6-7)

Sim 3

(weeks 8-9)

Sim 4

(weeks 10-11)

Sim 5

(weeks 12-13)

OB PEDS PSYCH

2251 -Laboring

patient

-NST

-Natural patient

-Laboring

assessment

-Different

culture

-Monica &

Tressa

-Well-child

assessment,

autism

-Well-Infant

assessment,

abuse

-Jaylynn, Carrie

-Dementia

-Alzheimers

-Family

interactions,

care giver role

strain,

communication

-Alex, Deon,

Nancy

-Diabetic wound

-Pressure injury

-Connie, Monica

-Renal failure,

Med

management,

-Med error

-Foley

-Connie, Monica

2351 -Well delivery

with newborn

recovery

-P/P

delivery/hemorr

hage

-Monica &

Tressa

-RSV-9 mo old

-Asthma- 5 yr

old

-Jaylynn, Carrie

-Detox

-Schizophrenia

-Alex, Deon,

Nancy

-Small bowel

obst., NG tube

-Ruptured

diverticulitis,

ostomy

-Pam, Marlene

-Cardiac-heart

failure

-CVA

-Pam, Marlene

2551 -Pre-eclampsia

on Mag with

non-reassuring

laboring, foley

-Abruption

leading to C/S

-Monica &

Tressa

-DKA child,

undiagnosed

type 1,

dehydration

-Newly

diagnosed teen,

Diabetic

management

-Jaylynn, Carrie

-Depression,

suicidal

-Bipolar

-Alex, Deon,

Nancy

-MVA, shock

-Sepsis, shock

-Rachel

-Cardiac, MI

-Cardiac, code,

Death/dying

-Rachel

Simulation Set-Up:

Patient Location: OB unit

Equipment attached to

the manikin:

[x] ID band

Equipment Available

in Room:

(check all the apply)

[x] Other (be specific): fetal doppler, pulse oximeter, blood

pressure cuff, glucometer, tape measure for fundal height

Medications & Fluids:

(be specific)

[x] IM Specific list: Rhogam 300 mcg IM at 28 weeks gestation

[x] PO Metformin 500 mg BID

Additional Props:

(Be Specific)

Manikin fundal height should be measured at approximately 28

cm.

Documentation Forms

needed during

Simulation:

[x] Other Diabetes patient education from Lippincott; Rhogam

information from the CDC

Simulation Roles:

State 1 The student should obtain vital signs, measure fundal height, obtain fetal

heart tones, assess fetal movement, and notify the physician of lab

results.

Simulator Programming: Temp 36.5

O2 Sats 99%

HR & rhythm 72 NSR

RR 18

BP 108/65

Breath sounds clear bilaterally

Pain 0/10

Fetal heart rate 145

Clinical presentation The patient is sitting in high fowlers in the bed. She can be in normal street

clothes (if available) since she is not admitted to the hospital.

Lab Results Blood glucose:

Fasting: 105; 1 hour: 187; 2 hours: 163; 3 hours: 155

Scenario Specific Content Observable Points

Cognitive: Identify negative blood type and need for rhogam

Student confirms with physician that the patient needs rhogam since she is 28 weeks.

Identify abnormal lab value Student obtains lab results in DocuCare and notes that glucose is high and reports to physician.

Affective: Provide education and emotional support in pregnancy

Student provides education about fetal kick counts when the fetus is less active.

Psychomotor: Complete focused assessment Student should obtain vital signs, listen to heart and lungs.

Obtain fetal heart tones Doppler fetal heart tones and determine heart rate at 145

Obtain fundal height Measure fundal height at approx. 28 cm

Notify physician Provide SBAR to physician regarding decreased fetal movement, glucose results, and negative blood type.

Document in the EHR Documents in DocuCare

STATE 1 - SCRIPTS

Patient

General:

Tara Hass. My birthday is June 16th

The baby has moved today but she has been less active than normal. The doctor told me I should be monitoring movement but I can’t remember exactly how many times or how often. Can you remind me about

that? That glucose test was awful. It is hard being pregnant and not eating for that long and drinking that awful drink. I sure hope the first test was a fluke. I can’t give up my chocolate peanut butter ice cream every night. It’s all I have been craving. I have felt a few pains in my lower abdomen. Is that normal? It’s right where my abdomen and leg meet.

MD

The nurses should give an SBAR report including Decreased fetal movements. Heart rate at 145 and is now active Glucose results from DocuCare. Lower abdominal pains Negative blood type and confirmation for rhogam

Give the following orders after you receive the above information:

Give Rhogam 300 mcg IM x 1 before discharge Educate patient on gestational diabetes; diet, glucose monitoring (4x daily; fasting and 2 hours post-prandial), when to call the office Provide glucometer and teach patient how to check glucose We need to start her on metformin, 500 mg BID. Give her a dose now and find out which pharmacy I can call in a prescription to.

INTRODUCTION• Increased State funding = increased student

admissions• Clinical sites saturated and unable to absorb

even small student increases• INASCL standards accept simulation as partial

replacement to clinical experiences• Current simulation structure needed to be

adapted to better engage students in all aspects of the experience

• Faculty to create simulation scenarios to meet new course outcomes

PROCEDURE• Faculty were surveyed about necessary

simulated experiences• Simulation scenarios were chosen, skill &

knowledge levels identified & placed in the curriculum, scenarios assigned to faculty fordevelopment

• Electronic charting system introduced & faculty received basic education to build scenarios within the system

• Summer 2019 allocated for writing scenarios evidence-based practice incorporated, simulation template used

• Faculty developed patient data, supply lists & staging related to each scenario.

• Faculty developed scripts & structure for role-playing within the simulation

OUTCOME• 30 new simulation scenarios were created• Simulations were run Fall semester 2019

Simulations were revised according to student and faculty feedback

• Students reported the new simulations were engaging and meaningful, use of role-play providing a rounded perspective

• Students reported the new simulations were engaging and meaningful