SUFFOLK COUNTY COMMUNITY COLLEGE SIM LAB ORIENTATION: STUDENT VERSION

Size: px

Start display at page:

Download "SUFFOLK COUNTY COMMUNITY COLLEGE SIM LAB ORIENTATION: STUDENT VERSION"

Kelly Lewis
7 years ago
Views:

1 SUFFOLK COUNTY COMMUNITY COLLEGE SIM LAB ORIENTATION: STUDENT VERSION 1

2 2 Tanner s Clinical Judgment Model 14 2

3 3 Patient Centered-Care Quality and Safety Education for Nurses Simulation Peer Review Tool (QB-PRT) 1. Was the patient and/or family involved in decision-making process? 2. Was there facilitation of informed patient consent for care? 3. Was effective communication provided at the time of care and with every transition in patient care? 4. Were common barriers to active involvement of patients in their own health care processes identified? 5. Was there an understanding of patient s needs based on ethnic, cultural or social background? 6. Was there timely response to a change in patient s condition? Teamwork and Collaboration 1. Was there effective communication with other members of healthcare team? SBAR 2. Was there collaboration with other members of healthcare team? 3. Was each role within the clinical scenario clearly defined? Quality Improvement 1. Was the use of flow charts or diagrams used for documentation? 2. Was patient and/or family education provided and documented? 3

Were common barriers to active involvement of patients in their own health care processes identified? 5. Was there an understanding of patient s needs based on ethnic, cultural or social background?

4 4 Evidenced Based Practice 1. Were guidelines for evidence based practice incorporated in patient care? (eg. VAP Bundle, screening tool identifying risk for DVT, assessment for catheter associated UTI s) 2. Was there assimilation of National Patient Safety Goals into patient care? 3. Was staff competent in knowledge of current literature supporting implementation of interventions? Safety 1. Were math calculations necessary for administration of medication? Were they done correctly? 2. Were 6 rights and 3 checks of medication administration practiced? 3. Was medication reconciliation included in data collection? 4. Was patient identified correctly using two identifying factors? 5. Were alarms identified and troubleshooting began in a timely fashion? 6. Were strategies for preventing infection implemented? (hand washing, aseptic technique) Informatics 1. Was information regarding patient s history and current condition obtained with use of electronic health record (EHR)? 2. Were medications elicited and referenced through NEHR? 3. Were lab and diagnostic tests correctly identified and retrieved using technological support? 4. Was documentation completed using EHR? 4

Was staff competent in knowledge of current literature supporting implementation of interventions? Safety 1. Were math calculations necessary for administration of medication?

5 5 Distinguishing between level 1 and level 2 students NUR 133 STUDENT Model of student learning experience in level 1 nursing lab Develop practice based knowledge Evaluate outcomes Design differential diagnoses and priorities Faculty coaching at the bedside Implement actions Perform focused assessment and compared against benchmarks Develop priorities of actions 10 NUR 240 STUDENT Model for student learning for level 2 simulation lab Noticing/focused assessment Reflecting/on action and learning to gain insight an d feedback Team approach/peer reviewed Interpreting /analysis Responding/collaboration, ethical comportment, skillfulness 16 5

compared against benchmarks Develop priorities of actions 10 NUR 240 STUDENT Model for student learning for level 2 simulation lab Noticing/focused assessment

6 FOCUSED ASSESSMENT RESOURCES O Onset- Exactly when did it start? When did you first notice it? P Provocative or palliative What brings it on? What where you doing when you first noticed it?

6 6 FOCUSED ASSESSMENT RESOURCES O Onset- Exactly when did it start? When did you first notice it? P Provocative or palliative What brings it on? What where you doing when you first noticed it? What makes it better? Worse? Q Quality and quantity How does it look, feel, or sound? How intense/severe is it? R Region or radiation Where is it? Does it spread anywhere? S Severity scale How bad is it (on a scale of 1 to 10)? Is it getting better, worse, staying the same? T Timing Is it constant or does it come or goes? Duration- How long did it last? Frequency- How often does it occur? U Understanding patients perception of the problem What do you think it means? Adapted from 6

R Region or radiation Where is it? Does it spread anywhere? S Severity scale How bad is it (on a scale of 1 to 10)? Is it getting better, worse, staying the same?

7 7 Simulation Phases: Key instructions Preparation Students must complete prep materials attend SIMS. Performance: PREconference Assign roles. The primary nurse is the presumed leader although leadership can be negotiated by participants. The second and third nurse can be delegated assessments etc. Explain that it is best for the primary nurse to delegate assessments, actions whenever possible. Assign an assistant to the primary nurse for point of care references and documentation. Allow students to develop background information about the client s current condition in order to prepare for an initial assessment. Encourage students to develop a diagnostic cluster according to current condition (admitting diagnosis) and comorbidities Divide diagnoses amongst group to develop focused assessment for each diagnoses in cluster as performed in Adult Health Nursing I. NUR 240 students check plans. Have students develop resources for accessing at point of care; texts, smart phones, etc to access guidelines and evidence based practice resources. Have students review documentation and seek clarification Role play focused assessment of the client with first year student. Preparation phase-role-play initial and focused assessment: Explain that anything can be delegated as necessary to expedite response to client s concerns. Simulation 1. Allow students to perform simulation with minimal prompts. Sim Mentors can offer guiding questions and assistance 2. When RRT is activated, prepare to function as RRT leader and provide orders 3. Encourage use of resources at point of care 4. Terminate simulation and restore client to original condition. 5. Switch assignments and repeat with second scenario. Debriefment Emphasize the importance of a coordinated interprofessional response to client in acute distress and explain what is at stake if not performed adequately. Go through the SQEN tool. Ask students to complete their self (NUR 133) and peer assessments (NUR 240) using the rubric. They rubric is completed by shading the boxes that correlate to the acheivement level. Collect rubric assessments for data collection. After reflection, encourage students to verbalize their impressions, insights and recommendations for improvement. Review the planning and care of a client experiencing the complication of dysrhythmia when experiencing acute myocardial infarction using the differential diagnostic list and the assess monitor do call framework. 7

Explain that it is best for the primary nurse to delegate assessments, actions whenever possible. Assign an assistant to the primary nurse for point of care references and documentation.

8 Electronic Clinical Record Fact sheet Student record for use in simulation to practice entering point of care documentation electronically and for interpreting clinical decision support resources;

8 8 Electronic Clinical Record Fact sheet Student record for use in simulation to practice entering point of care documentation electronically and for interpreting clinical decision support resources; referential and pushed. Access database in early design for use in the SIM lab to document using SnomedCT nursing Problem List subset and accessing clinical information resources. Focus is on accessing two records; assessment flowsheet and focus notes to meet informatics competency. Getting started: 1. Open access by double clicking on icon on desktop 2. Select the clinical record and double click 3. This opens a navigation screen below: scroll down to forms and select SIM CHART 4. This opens the chart view: 8

Access database in early design for use in the SIM lab to document using SnomedCT nursing Problem List subset and accessing clinical information resources.

9 5. Navigating the chart with the forms. Just point and click with mouse: a. The forms to access are as follows: i. Student enrollment: Select to have student enter student info ii.

9 9 5. Navigating the chart with the forms. Just point and click with mouse: a. The forms to access are as follows: i. Student enrollment: Select to have student enter student info ii. Sim encounter: completed for the purpose of establishing sim client in record iii. Patient report: to be used when students are practicing receiving report information iv. Sim assessment flowsheet: To be used by student at point of care to record assessment data. Has links to assessment resources v. Focus notes: To be used by leader in sims when problem is identified and plan is developed and implemented Uses a searchable Snomed CT nursing problem List codes and has referential information b. The database has the ability to house all relevant record for the SIMS activities. For now; faculty are being ed sims documents to review and prepare before the scheduled sims activity 6. Have the student select student enrollment and advance the record on the bottom of the screen using the arrows next to record until you are at a new record. 7. Enter information requested. Repeat entering infor with SIM Encounter form 8. Select Assessment flowsheet 9

Sim assessment flowsheet: To be used by student at point of care to record assessment data. Has links to assessment resources v.

10 10 1. Have the student advance the record on the bottom of the screen using the arrows next to record until you are at a new record. 2. Have the student select the sim encounter ID (correlates to patient name in sim encounter form) 3. Enter information requested. 4. The student uses the systems navigation at the top of the form to go to separate systems of assessment. Reinforce that the purpose of the SIMS is to do focused assessment not comprehensive assessment and this form is to guide H&P. Once a cue indicates that the focused assessment is present for a nursing diagnosis or collaborative problem, they will exit this flowsheet and go to focus notes. 5. When entering focus notes, have the student advance the record on the bottom of the screen using the arrows next to record until you are at a new record. 6. Enter information requested to fill in. 7. Students can access referential information from this form. The diagnostic clusters or problem list will have cues for data collection. The focus charting info reviews focus charting. The links go to reference sources on the internet. 10

The student uses the systems navigation at the top of the form to go to separate systems of assessment.

11 8. The diagnostic cluster index will be populated with diagnostic clusters that correlate to explanations and descriptions of focused data.

11 11 8. The diagnostic cluster index will be populated with diagnostic clusters that correlate to explanations and descriptions of focused data. This will be set up for simulation clients first, then, NUR 133, 240 topics. The label can be copied using Control C after highlighting then placed in the Focus box with control V 9. The problem box is for using the SnoMed CT nursing problem list. Hit the drop box arrow them start to type a diagnostic label. It will take time for students to use this since they are unfamiliar with the labels. These are all coded according to standards for the EHR. 11

The label can be copied using Control C after highlighting then placed in the Focus box with control V 9.

12 12 1. Have students enter pertinent data for focus in data space 2. Enter interventions in action box 3. Enter evaluation using s/o data in response box. This chart is a work in progress. Expect that updates will be made and shared with faculty through college . 12

Enter evaluation using s/o data in response box.

College of DuPage. Associate Degree Nursing Program

College of DuPage. Associate Degree Nursing Program Student Name: Clinical Instructor: Clinical Site : College of DuPage Associate Degree Nursing Program Clinical Evaluation Tool: Nursing 1220 Health and Illness Concepts I Student Learning Outcome 1. SAFETY: