Simulation Design Template

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Nathaniel Tate
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1 Simulation Design Template Date: May 7, 2008 Discipline: Expected Simulation Run Time: 20 mins Location: hospital ER Admission Date: Today s Date: Brief Description of Client Name: Mr. Crash Gender: M Age: 52 Race: Caucasian - Wife died in crash Weight: 70 kg Religion: Atheist Major Support: Spouse Phone: Allergies: penicillin Immunizations: N/A Attending Physician/Team: - ER team - Dr. M. Welby Height: 175 cm Past Medical History: smoker, bleb, emphysema. History of Present illness: air bag deployed, restrain driver, seat belt injury Social History: employed, married with children, no hobbies, traveled with wife. Primary Medical Diagnosis: MVC chest trauma, mild SOB deteriorates Surgeries/Procedures & Dates: none File Name: Student Level: Pre integrative practicum Guided Reflection Time: 20 mins Location for Reflection: quiet room Psychomotor Skills Required Prior to Simulation - Information package background of different professions - All professionals should have communication skills Triage nurse (RN) - Communicate with interprofessional disciplinary - Assign CTAS - Inform physicians on patient s change of status RPN - Quick head to toe assessment - History, vital signs - Communicate with paramedic - Notify RN on change in status re: respiratory (if patient become unstable) Cardio tech - ECG - X ray Lab Tech - Blood work Paramedic - Oxygen therapy - IV access - Spinal stabilization - Quick head to toe assessment - History, vital signs - Communicate with interprofessional disciplinary - Assign CTAS

Physician/Team: - ER team - Dr. M. Welby Height: 175 cm Past Medical History: smoker, bleb, emphysema.

2 Cognitive Activities Required prior to Simulation [i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)] - Preparations reading (current practice guidelines) - Knowledge of roles for other disciplines - Knowledge of CTAS (if applicable) - Review assessment skills - Conflict management (R) - Identify leadership - Every profession would have an information package. Scenario - MVA multi MVA - Wife died at the scene of accident - No confirmation on wife s status. Strong predication communication breakdown (professionalism) - Patient taken to ER - ER overwhelmed from multiple crash - Paramedic offload delay - Bed shortage/staff shortage - Patient is stable chest injury - Vital sign stable - Not skilled scenario but focus on interdisciplinary communication - Stable patient will be assessed by student or student can be observer

Required prior to Simulation [i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)] - Preparations reading (current practice guidelines) - Knowledge of roles for

3 Simulation Learning Objectives 1. Interdisciplinary communication 2. Access appropriate resources assessing situation (critical thinking) 3. Identifying when transfer care is appropriate (whose role at certain point during the situation) - When are you the primary care 4. Defining role, respectful of disciplinary professionals defining priority of role - Identifying the change of role collaboration of care /communication (2 ways) respectful ways of identifying role of care. - Patient center care - Educating other disciplinary for our role of care and why it s important to perform certain care first - Negotiation of task priority 5. Communicate/collaborate for proper time efficient care

Defining role, respectful of disciplinary professionals defining priority of role - Identifying the change of role collaboration of care /communication (2 ways) respectful

4 Fidelity (choose all that apply to this simulation) Setting/Environment Medications and Fluids o ER o IV Fluids: 2/3&1/3 Ringers Lactate, N/S, Simulator Manikin/s Needed: 1 Props: IV pole, Oxygen tank, O 2 tubing, vital signs equipment, stretcher, cervical collar, X ray machine, lab tech cart for blood work, ECG machine, dressing cart, safety precautions. Equipment attached to manikin: o IV tubing with primary line normal saline fluids running at 30 cc/hr o 02: non re-breather mask o Monitor attached: cardiac monitor o ID band put on by triage nurse Equipment available in room Bedpan/Urinal 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 Pressure Bag o 02 delivery device (type) o Crash cart with airway devices and emergency medications o Defibrillator/Pacer o Suction o Other o Oral Meds: Ativan, Nitro Spray o IVPB: o IV Push: Morphine, and drugs from crash cart o IM or SC: Tetnus Diagnostics Available o Labs o X-rays (Images) o 12-Lead EKG o Other Documentation Forms o Flow sheet o Graphic Record o Shift Assessment o Triage Forms o Code Record o Standing (Protocol) Orders o Transfer Orders o Other Recommended Mode for Simulation (i.e. manual, programmed, etc.) Programmed, with on the fly conversation

Equipment attached to manikin: o IV tubing with primary line normal saline fluids running at 30 cc/hr o 02: non re-breather mask o Monitor attached: cardiac monitor o ID band put on by triage nurse

5 Roles / Guidelines for Roles o Primary Nurse RN triage nurse o Secondary Nurse- RPN pulled from medical floor to help with overloaded ER o Clinical Instructor- available for debrief immediately following scenario o Recorder 1 recorder o Physician / Advanced Practice Nursefaculty will be Physician if called for orders o Lab- 1 lab tech o Imaging- 1 radiology tech o Social Services- faculty will answer for social worker if called on o Clergy- faculty will answer for clergy if called on o Other_Ambulance Attendent Important Information Related to Roles Primary Nurse will coordinate care Secondary Nurse will carry out care within their scope of practice Clinical Instructor will be available for debrief immediately following simulation, and will also be available by phone to answer for the physician, social services, and clergy roles Recorder will document care as it happens Lab Tech will be called on for blood draw during critical situation Xray Tech will also be called on for diagnostic imaging during critical situation Ambulance attendant will have to stay with pt during this crisis, as they are still responsible for pt due to off load delay 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 Time: Pt in multi vehicle accident 1 hr ago. Air bag deployed and seatbelt on. Pt brought to emerg via ambulance with stable chest injury. Wife died in accident. Pt is not aware of this but is questioning where his wife is. Due to multiple accident victims there has been an off load delay, therefore ambulance attendant must stay with pt until he is transferred over to a hospital stretcher. This scenario involves several health care disciplines and will require interdisciplinary collaboration Significant Lab Values

will answer for social worker if called on o Clergy- faculty will answer for clergy if called on o Other_Ambulance Attendent Important Information Related to Roles Primary Nurse will coordinate care

6 Physician Orders

7 References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For This Scenario: (site source, author, year, and page)

8 Timing (approximate) Scenario Progression Outline Manikin Actions Expected Interventions May Use the Following Cues Role member providing cue: Cue: Role member providing cue: Cue: Role member providing cue: Cue: Role member providing cue: Cue: Role member providing cue: Cue:

providing cue: Cue: Role member providing cue: Cue: Role member

10 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

Did you have the knowledge and skills to meet objectives? 5. Were you satisfied with your ability to work through the simulation? 6.

University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Circulation: Congestive Heart Failure.

University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Circulation: Congestive Heart Failure. Simulation Scenario Circulation: Congestive Heart Failure Overview Title: Congestive Heart Failure Concept: Circulation To cite this reference: Target Group: First Year Nursing Students Johnson-Anderson,