Simulation Experience

Simulation Experience
Cynthia Cummings, RN, MSN, EdD
M. A. (Bonnie) Holder, PhD, ARNP
History at UNF
 First HFPS obtained in 2007
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Sparsely used/Not to full potential
 Health Assessment only
 Lack of training for faculty
 No IT support
 In 2010 new faculty assigned to Simulation
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Initially Self taught training
 School paid for Laderal to provide training for 6 faculty
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Two faculty actively involved in simulation, others
starting
 Part time IT support
Simulation Equipment
 3 G Laderal mannequin
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Video recording equipment
2 current cameras
 Simulation area
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No facility modification for special rooms or gas
 Three rooms with central “control” area
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Hospital Room set up for undergraduate
 Hospital bed
 Pseudo suction and oxygen headboard
 IV pumps/Medication cart/Supply “closet”
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Operating room with anesthesia machine for CRNA
Equipment
Equipment
Funding
 Original funding for HFPS and equipment from
a HRSA grant written by anesthesia
 Further funding for supplies and equipment
from school operating budget.
 Teaching grant awarded this summer to further
develop integration of simulation across the
curriculum
Faculty Involvement
Rogers,E.M. (2003). Diffusion of Innovations, 5th ed. New York: Free Press.
 Relative Advantage
 Compatibility with staff
 Complexity
 Trialability
 Observability
 How do we make this happen?
Faculty Innovation
 Become Change Agents
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Attended Laerdal SUN conference
 Practiced with equipment
 Worked with Computer assistant to develop scenarios
 POSITIVE about product
 Talked up the system to other faculty
 Allowed them to come watch our sessions
Faculty Growth
 Our administration encourages the use of simulation
and other technologies
 Encourage other courses to incorporate scenarios
and work with them to develop their plan
 5 Stages:
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Knowledge
Persuasion
Decision
Implementation
Confirmation
 We need to make it user friendly, so that they would
be willing to try the simulations
Faculty Benefits
 Biggest benefits is evaluation of student
comprehension of:
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Techniques
Medication administration
Assessment techniques
Evaluation of patient responses
Safety factors
Patient and family interaction
SBAR and physician communication
Interdisciplinary communication
Critical thinking in a variety of situations
Documentation
Simulation Benefits
 Student learning takes place in a safe
environment
 No harm to the patient can occur
 Students can practice skills, discuss
medication processes
 Contact physicians and staff without reprimand
 Learn in real world scenarios and stressful
events without actual consequences
 View the debrief sessions to understand their
behaviors
Putting the Plan to work
 Decided to change the adult health curriculum
to incorporate simulations
 Studied other on-line systems, such as Evolve
by Elsevier to look at scenarios and student
involvement
 Agreed to have all adult health students attend
two simulation sessions.
 Incorporated Pre and Post activities with the
scenarios
Simulation Scenarios
 Utilized the NLN
scenarios and
developed our own
based on Evolve
situations
 Used an evolve
workbook to add
trends and handlers
 Incorporated voices,
xrays, labs, etc
Scenario Development
 Started with the NLN off the shelf product
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Did own “voices”
 Then developed 6 Adult Health scenarios from
class content
 Asthma- 33 yr old female admitted with acute attack
 Diabetes- 60 yr old homeless man with hyperglycemia and
a foot ulcer
 Renal Failure- 82 yr old female with renal failure, breast
cancer and medication needs
 Cardiac- 50 yr old male with chest pain and potential MI
 Abdominal mass- 60 yr old female with possible abdominal
cancer requiring and NGT and pain medication
Student Responsibilities
 Arrive 15 minutes prior to schedule
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Dressed in their clinical uniform bring appropriate equipment
 Required to go online and review the scenario prior to their
session
 Complete the online Pre-simulation exercises and quiz
 Following the simulation
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Review their video and provide critique
Complete on line Post simulation exercises and a quiz.
Document their care and record their reflections
 These are evaluated for completeness and comprehension.
 The students are not assigned grade
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But incomplete assignments are documented under their clinical
evaluation for the course
Junior vs Senior Experiences
 Juniors were in the Adult Health Course and
followed the previous slide requirements
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Assigned in groups of 2-3 students and were told of the
scenario they were assigned in advance
 Seniors were in their final Professional Role
Integration Course
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Not assigned scenarios in advance
Simulation experience is done as a “solo” nurse provider
Scenario chosen randomly from 10 possibilities
Did not have a previous simulation experience
 Their performance was graded and was 20% of
the course grade
Senior Grading Rubric
 Introduction, explanation of events
 Assessment and ROS
 Plan & Communication with MD/Staff
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10%
20%
15%
Including utilization of SBAR and read-back
 Implementation of Interventions
25%
 Evaluation of actions and reassessment 10%
 Documentation
20%
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Using Cerner computer doc system
Admission assessment
SBAR form
Plan of Care with priorities
Simulation reflection
Lessons Learned
Senior Simulation Experiences
 Of 80 students, we found the following issues:
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43 did not remember a medication usage, side effects or
implications
26 did not read-back
22 incomplete ROS, missed allergies, meds at home and PMH
15 not know lab values on Chem 7 or ABG’s
12 not know the rhythm strip
12 not follow ABC’s, not correct priority
11 not follow correct procedure for IVP or IVPB
10 not follow correct procedure for resp. equipment
9 not perform assessment correctly (listened over pt. gown)
5 not follow medication rights
4 not follow universal precautions
Student Responses
 Student responses were as follows:
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“overall I think I did well, I stayed calm and focused on my
patient’s needs”
“I forgot to read the orders back, the actual experience is
intense!”
“it is one of the best learning tools in the nursing program”
“I need to work on my interview techniques, I missed some
important questions and I didn’t know the medication side
effects”
“it was a good experience, I realized the importance of
getting a history before calling the MD”
“I felt like I was very slow and I didn’t know how to read the
EKG, I thought I knew that?”
Student Responses
 “I think I did really well, I’m actually feeling better about
my abilities now”
 “I forgot some important things, like reassess the vital
signs and I didn’t pick the best time for diabetic teaching”
 This was really helpful, I was completely independent, so
it showed my strengths and weaknesses. Dr. Cummings
really challenged me and refreshed my skills and
memory.”
 “Boy, do I have room for improvement, I was surprised I
could interpret lab findings, but I forgot to read back the
orders and they went really fast.”
 “I was really nervous in the beginning, I missed some
steps, but this is a great learning toll and I wish we could
do more.”
Faculty Responses
 Great tool for evaluation of student learning
 Reflects real world activities
 Incorporates other disciplines
 Allows for student critical thinking without faculty
interaction
 Allows for student reflection and self-direction
 Great tool to see what areas need improvement,
such as medication safety, SBAR, communication
techniques
 Allows faculty to evaluate clinical learning
experiences and see if any incorrect behaviors have
been adopted
Future
 Continue to work on scenario development
 Asked graduate students to assist in scenario planning
 Look at other online resources, actually using a different
plan this fall
 Look at other equipment and supplies, obtained a
research grant
 Continue to encourage other faculty to utilize the lab
 Presently we have:
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Adult Health
Professional Integration
Pediatrics/OB
Psych/Rehab
CRNA program