BSN Leadership & Management Simulation: Critical Thinking Practice for Delegation, Prioritization, and Patient Safety Decisions

Transcription

1 BSN Leadership & Management Simulation: Critical Thinking Practice for Delegation, Prioritization, and Patient Safety Decisions Donna Copenhaver, EdD, MSN, RN Sandy Murabito, EdD, MSN, RN Overview of Current Simulation for BSN Students Achievement of delegation competency for BSN students working with LVN s & UAP s Opportunities to practice communication with LVN s and UAP s using delegation, prioritization, and scope of practice knowledge The Joint Commission National Patient Safety Goal knowledge and supervision of patient safety Why Simulation? Current healthcare environment requires the RN to collaborate, use multidisciplinary team approaches to provide safe patient care Consistent opportunities unpredictable for BSN senior students during traditional clinical Opportunity to reinforce didactic/theoretical principles and individual assessment of learning opportunities 1

2 Pre Simulation Student Briefing Review syllabus objectives with students: Appropriate delegation and prioritization of duties that support Tennessee Nurse Practice Act Knowledge of the National Patient Safety Goals Use of SBAR guidelines Demonstrate appropriate conflict resolution strategies Pre instruction conducted over 30 minutes, including additional instruction to students in Charge Nurse role Simulation Environment Two patients for each care team: Charge Nurse, RN, LVN, UAP, and Quality Auditor Cameo participation of Physical Therapist, Pharmacist, Family Member Same Lab space as Adult Health II: Students familiar with supplies/resources Resources include: Charts, PYXIS, Telemetry L & M Simulation Case Study Each team of students assigned to two patients that provide opportunities for critical thinking and making decisions that will impact patient safety Critical thinking decisions may include communication with multi disciplinary team members Use standardized patient scenarios National League of Nursing 2

3 Simulation Game Plan Nursing team includes: Charge Nurse, RN, LVN, UAP, and Quality Auditor Charge Nurse makes patient care assignments RN/LVN delegates to UAP, RN delegates to LVN, LVN delegates to UAP Quality Auditor evaluates knowledge of staff regarding National Patient Safety Goals during simulation Conflict resolution embedded in each participants presimulation instructions with name tag Patient Case Studies Standardized Lindsey Markham Two day post op hip replacement Allergic to PCN Complains of leg pain, and itching since late last night Will not wear TED hose Joseph Hill Homeless veteran, very independent Type I diabetic, bilateral severe cataracts, post op laryngectomy (day four) Plan to discharge tomorrow, return for surgical revision in one month Right heel is ulcerated Simulation Begins! Charge Nurse makes patient assignments and gives verbal report to RN, LVN, UAP (after receiving verbal report from night supervisor) Quality Auditor rounds during shift report Team members interact with their assigned patient(s) Communication styles will vary depending on pre simulation instructions found in name tag 3

4 Critical Thinking Lindsey Markham Allergic to PCN/Received Keflex on night shift Must problem solve complaint of leg pain Further questioning of patient should lead to decision regarding possible DVT Where does pain originate? Incision site? Calf? Where on leg? Communicates with Physical Therapist/Quality Auditor/Pharmacist Delegates to UAP/LVN? Joseph Hill Critical Thinking Morning blood glucose/breakfast Communication challenges/joseph can t speak clearly, and vision is very poor Wants to be discharged, says he can handle diabetes without help Independent, doesn t want to return for follow up care, prefers homeless shelters Communication with Quality Auditor/Pharmacist Faculty Facilitating Learning Directs critical thinking pathway in caring for patient Asks questions that will allow student to verbalize their current knowledge related to scope of practice for LPN and UAP Can the LVN give narcotic medication in thigh/intramuscular? Will you ask the UAP to rub my calf? Will you please remove my TEDS? Respond to student questions for Pharmacist, Physical Therapist, and Quality Auditor 4

5 Simulation: Time UP! minute active simulation activity Debriefing begins immediately after Simulation Encourage interaction between students, including expression of excitement, frustration, and unanswered questions Begin with reminder.no rights or wrongs! Simulation Best Practice Debriefing process is to be conducted by a person competent in the process of learning, according to International Nursing Association for Clinical Simulation Standards (2014). Debriefing Session Structured debriefing facilitated by Nursing Faculty Debrief by Role Debrief by Case Study/Key Indicators Request students to verbalize their individual learning opportunities experienced during Simulation Additional individual reflection occurs within Journal assignment 5

6 Charge Nurse Debrief Systematically review Charge Nurse initial decisions: Assignment of team members? Why? Hindsight? Why? Communication challenges? Patient care and safety? RN Debrief Review RN decisions: Delegation to LVN/UAP? Conflict resolution? UAP working outside of scope of practice LVN attitude related to scope of practice Decision making: Planning care for Joseph Hill after discharge? Itching Lindsey Markham? Leg pain Lindsey Markham? LVN Debrief Review LVN decisions: Ability to care for Joseph Hill and/or Lindsey Markham Highlight skills appropriate for LVN Interactions with RN and Charge Nurse Delegation to UAP Communication with Joseph Hill 6

7 UAP Debrief Review UAP decisions/actions: Care of Joseph Hill and Lindsey Markham Limitations/opportunities Conflict related to UAP role Quality Auditor Debrief Review Quality Auditor decisions: Quality Auditor requested to share verbally their observations during the simulation related to patient safety practices and opportunities for improvement Current National Patient Safety Goals highlighted Value of student Quality Auditor commenting/observing peers Ability to highlight consistent practices observed and areas of concern peer to peer Evaluation of Expected Outcomes Formative Provides feedback to improve knowledge, skills, and attitudes assessed during simulation Summative Feedback concerning the achievement of the simulation objectives High Stakes Not currently utilized Grades for this simulation based on preparation, participation, and completed journal assignment 7

8 Simulation Learning Outcomes Journal assignment post simulation requires student to describe their role in achieving learning objectives: Must assess their own use of SBAR during report Conflict resolution strategies National patient safety goal activities Delegation/prioritization challenges Communication with Pharmacist, Physical Therapist, and Quality Auditor Simulation Best Practice Use of an electronic Student Evaluation Form of Simulation is used to collect student perceptions and input related to simulation learning experience. This data is summarized by Belmont University Simulation Director. Simulation 2015 Opportunities for Improvement? Standardized volunteers acting as patient voices Video taping for student review/debrief Technology support Funding for resources 8

9 References Chunta, K. & Edwards, T. (2013). Multiple-patient simulation to transition students to clinical practice. Clinical Simulation in Nursing, 9, e491-e496. International Nursing Association for Clinical Simulation & Learning. (2014). Standards of best practice simulation. Retrieved from inacsl.org Josephsen,J. & Butt, A. (2014). Virtual multipatient simulation: A case study. Clinical Simulation in Nursing, 10, e235-e240. Kaplan, B. & Ura, D. (2010). Use of multiple patient simulators to enhance prioritizing and delegating skills for senior nursing students. Journal of Nursing Education, 49(7), 377. References Poore, J.A., Cullen, D.L., & Schaar, G.L. (2014). Simulation-based interprofessional education guided by Kolb s experiential learning theory. Clinical Simulation in Nursing, 10, e241-e247. Radhakrishnan, K., Roche, J.P. & Cunningham, H. (2007). Measuring clinical practice parameters with human patient simulation: A pilot study. International Journal of Nursing Education and Scholarship, 4(1), Simones, J., Wilcox, J., Scott, K., Goeden, D., Copley, D., Doetkott, R. & Kippley, M. (2010). Collaborative simulation project to teach scope of practice. Journal of Nursing Education, 49(4), Smith, S.B. (2013). Integrating simulation in a BSN leadership and management course. Journal of Nursing Education and Practice, 3(11),