Simulation Design Template

Simulation Design Template Date: 2013 Discipline: Nursing Expected Simulation Run Time: 20 Min Location: Room 432 Admission Date: 2013 Date: Today’s Brief Description of Client: Name: Mr. G.K. Ackah Gender: M Age: 75 Race: African from Ghana Weight: 180 lb. Height: 6’ 2”-cm/in Religion: Catholic Major Support: Daughter, Sister, Son- inlaw, and local church family. Phone: 240-567-5665 Allergies: Penicillin Immunizations: Influenza Attending Physician/Team: Dr. Montgomery Past Medical History: HTN, otherwise unremarkable History of Present illness: Patient was admitted through the ER yesterday c/o retention of urine and headache “on and off” for one week. MD has discussed Transurethral (TURP) surgery. Patient is visiting his daughter from Ghana. She is a professor at a local college in the US. This is first time in the US. Social History: Very active at church. Fluent in Nzema, French, Italian and English Primary Medical Diagnosis: Benign Prostatic Hyperplasia.(Enlarged Prostate) Surgeries/Procedures & Dates: Chest X-ray File Name: Intro to Cultural Student Level: All levels Guided Reflection Time: 40 Min Location for Reflection: Room 432 Psychomotor Skills Required Prior to Simulation: Communication Head to toe assessment Vital Signs Cognitive Activities Required prior to Simulation [i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)] *This simulation can be a stand- alone simulation; however, it was first revealed to students following a pre-simulation staff facilitated workshop to introduce the participants to considerations of cultural competence in nursing care—the journey toward cultural competency, unconscious bias and cultural humility. This workshop was highly interactive using both instructive learning activities and video clips. Following each activity and video clip, the participants were then debriefed. As with each debriefing, the participants were asked activity or video specific questions and then, as with each, the participants: explored general comments or impressions; the relevance of the activity or clip to cultural competency; and, relevance of the activity or clip to their work as nurses. http://ce.nurse.com/content/ce570/mind-yourmanners-multiculturally/ http://www.youtube.com/watch?v=zlfKdbWwruY http://www.youtube.com/watch?v=Pwe-pA6TaZk www.youtube.com/watch?v=AEmRfxxGGcE http://www.teachertube.com/viewVideo.php?video_id=66954 http://www.youtube.com/watch?v=SaSHLbS1V4w Review Pathophysiology on TURP Acute complications of TURP Review S/S of Enlarged Prostate Simulation Learning Objectives: 1. Students will recall and implement appropriate safety measures particularly related to informed consent and preoperative preparation. 2. Students will identify the most important focused assessment. 3. Students will identify the cultural needs of the patient and family, and implement these needs as appropriate in the care provided. 4. Students will communicate effectively with the patient, family members and the health care team as required. Fidelity (choose all that apply to this simulation) Setting/Environment Medications and Fluids o ER o IV Fluids: Normal Saline o o o o o o o o o Med-Surg Peds ICU OR / PACU Women’s Center Behavioral Health Home Health Pre-Hospital Other _________________ Simulator Manikin/s Needed: Props: Equipment attached to manikin: o IV tubing with primary line ____NS_______ fluids running at ____100______ cc/hr o Secondary IV line __ running at _ cc/hr o IV pump o Foley catheter ________cc output o PCA pump running o IVPB with Rocefin ___ running at __45_ cc/hr o 02 : o Monitor attached o ID band: R hand______ o Other__Allergy Band__________________ o Oral Meds: o IVPB: Rocefin o IV Push: o IM or SC: Diagnostics Available o o o o Labs X-rays (Images) 12-Lead EKG Other__________________ Documentation Forms o o o o o o o o o o o o o Physician Orders Admit Orders Flow sheet Medication Administration Record Kardex Graphic Record Shift Assessment Triage Forms Code Record Anesthesia / PACU Record Standing (Protocol) Orders Transfer Orders Other Consent Form Equipment available in room Bedpan/Urinal Foley kit Straight Catheter Kit Incentive Spirometer Fluids IV start kit IV tubing IVPB Tubing IV Pump Feeding Pump Pressure Bag 02 delivery device (type) Crash cart with airway devices and emergency medications o Defibrillator/Pacer o Suction o Other_________ o o o o o o o o o o o o o Recommended Mode for Simulation (i.e. manual, programmed, etc.) Roles / Guidelines for Roles o o o o o o o o o o o o o o o o o o o Primary Nurse Off Going Nurse Clinical Instructor Family Member #1 Family Member #2 Family Member # 3 Observer/s Recorder Physician / Advanced Practice Nurse Respiratory Therapy Anesthesia Pharmacy Lab Imaging Social Services Clergy Unlicensed Assistive Personnel Code Team Other: Church Members Important Information Related to Roles Roles can be divided depending on the amount of students. Significant Lab Values Urinalysis Physician Orders: Possible TURP surgery Rocephin IV 0.9% Normal Saline 100ml/hr 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: This is Mr. G.K. Ackah who was admitted yesterday complaining of urinary retention and a headache “on and off” for a week. The admitting physician, Dr. Montgomery, diagnosed him with Benign Prostatic Hyperplasia (BPH). Dr. Montgomery has spoken to patient about possible TURP surgery and patient has given oral consent. The patient needs to sign the consent for surgery. Patient is cooperative, alert and orientated X4. He is well educated and is a retired English Professor. This hospitalization occurred during Mr. Ackah’s first visit to the US from Ghana. He has been here for one month visiting his youngest daughter. His daughter is a health care professional and also teaches at an Urban Community College. His vitals have been stable since admission. He has a Normal Saline infusing in the primary with IV antibiotic in secondary on the right for arm. Time: 20 Minutes References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For This Scenario: (site source, author, year, and page) Jefferys, M. R. (2010). Teaching Cutural Competence in Nursing and Health Care. New York, NY 10036: Springer Publishing Company LLC. Lewis, H. D. (2007). Medical Surgical Nursing . St LOIUS : MOSBY, ELSEVIER. Lynn, P. (2011). Taylor's Clinical Nursing Skills. Anursing Appraoch . Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins. Pellico, L. H. (2013). Focus on Adult Health Medical Surgical Nursing . Philadelphia : Wolter Kluwer/Lippincotts Williams & Wilkins. Purnell, L. D. (2009). Guide to Culturally Competent Haelth Care. Philadelphia, PA : F.A Davis Company. http://www.youtube.com/watch?v=WWWxy8o4SzA http://www.youtube.com/watch?v=XWAdGKY8GB8 http://www.youtube.com/watch?v=ceB0AVVq8CI http://www.youtube.com/watch?v=qzOtedQS0Jc http://www.youtube.com/watch?v=e0VDLPkq0vE http://www.youtube.com/watch?v=ctDMxzabRSo http://www.youtube.com/watch?v=kDLris3x39M http://youtu.be/2uQNLFtx_x4 http://www.youtube.com/watch?v=cm44xnxIJro http://www.youtube.com/watch?v=asUqGmMBGW4 2013 NCLEX-RN® Test Plan Categories and Subcategories Choose all areas included in the simulation Safe and Effective Care Environment Management of Care ● ● ● ● ● ● ● ● ● ● Advance Directives Advocacy Case Management Client Rights Collaboration with Interdisciplinary Team Concepts of Management Confidentiality / Information Security Consultation Continuity of Care Delegation Safety and Infection Control ● ● ● ● ● ● ● ● Accident Prevention Disaster Planning Emergency Response Plan Ergonomic Response Plan Error Prevention Handling Hazardous and Infectious Materials Home Safety Injury Prevention Health Promotion and Maintenance ● ● ● ● ● ● ● ● ● Aging Process Ante/Intra/Postpartum and Newborn Care Developmental Stages and Transitions Disease Prevention Expected Body Image Changes Family Planning Family Systems Growth and Development Health and Wellness Psychosocial Integrity ● ● ● ● ● ● ● ● ● ● Abuse/Neglect Behavioral Interventions Chemical and Other Dependencies Coping Mechanisms Crisis Intervention Cultural Diversity End of Life Care Family Dynamics Grief and Loss Mental Health Concepts ● ● ● ● ● ● ● ● ● ● Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Rights and Responsibilities Performance Improvement (QI) Referrals Resource Management Staff Education Supervision ● ● ● ● Medical and Surgical Asepsis Reporting of Incident/Event/ Irregular Occurrence/Variance Security Plan Standard /Transmission-Based / Other Precautions Use of Restraints/Safety Devices Safe Use of Equipment ● ● ● ● ● ● ● ● ● Health Promotion Programs Health Screening High Risk Behaviors Human Sexuality Immunizations Lifestyle Choices Principles of Teaching/Learning Self-Care Techniques of Physical Assessment ● ● Psychopathology Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Situational Role Changes Stress Management Support Systems Therapeutic Communications Therapeutic Environment Unexpected Body Image Changes ● ● ● ● ● ● ● ● ● Physiologic Integrity Basic Care and Comfort ● ● ● ● ● Assistive Devices Complementary and Alternative Therapies Elimination Mobility/Immobility Non-Pharmacological Comfort Interventions Pharmacological and Parenteral Therapies ● ● ● ● ● ● Adverse Effects/Contraindications Blood and Blood Products Central Venous Access Devices Dosage Calculation Expected Effects/Outcomes Medication Administration Reduction of Risk Potential ● ● ● ● ● Diagnostic Tests Lab Values Monitoring Conscious Sedation Potential for Alterations in Body Systems Potential for Complications of Diagnostic Tests/Treatments/Procedures Physiologic Adaptation ● ● ● ● ● Alterations in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management Infectious Diseases ● ● ● ● Nutrition and Oral Hydration Palliative/Comfort Care Personal Hygiene Rest and Sleep ● ● ● ● ● Parenteral/Intravenous Therapies Pharmacological Agents/Actions Pharmacological Interactions Pharmacological Pain Management Total Parenteral Nutrition ● ● ● ● Potential for Complications from Surgical Procedures and Health Alterations System Specific Assessments Therapeutic Procedures Vital Signs ● ● ● ● Medical Emergencies Pathophysiology Radiation Therapy Unexpected Response to Therapies This Scenario was prepared with the view toward implementing QSEN KSA’s competencies. Patient-Centered Care Teamwork and Collaboration Evidence-based Practice (EBP) Quality Improvement (QI) Safety Informatics (http://qsen.org/competencies/pre-licensure-ksas/) Timing (approximate) 5 Minutes Scenario Progression Outline Manikin Actions Expected Interventions Initial State: R 18, HR 100 BP 142/96 SPO2 92 on RA Temp 99.2F Patient sleeping quiet Vital signs Basic safety: Hand hygiene, therapeutic communication Two Patient ID Assessing patient’s readiness for surgery. Performs assessment. 10 minutes 15 minutes 20 Minutes Patient is avoiding eye contact with nurse and continues to be agreeable to all that is asked. Focused physical assessment of patient Patient quiet and trying to calm daughter down so she complies with the physician recommendation and need for consent. Possible discussion of TURP surgery to patient, Notify MD using SBAR. Try to understand patient and family culture about decision making. Appropriate communication to ascertain patient-centered care. Patient and Daughter involved in discussion Nurse excuses family providing privacy. Review MD orders and discussion/questioning of patient for confirmation of consent. May Use the Following Cues Role member providing cue: Manikin Cue: Patient is saying yes to every open ended questions that is being asked. Role member providing cue: Family Member Cue: Family member enters room and interrupts the nurse conversation and ask what consent we are talking about? Role member providing cue: Manikin Cue: Role member providing cue: RN/ Manikin Cue: Family member suggests that we need t 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 1. For the beginning student, the focus is on recognizing and understanding the cultural implications in the scenario. 2. For the advanced students, the goal is to implement cultural consideration in the care they provide. For the student to understand their own cultural values that might come in play and the Addendum Focus of the scenario Patient is a father admitted for possible surgery. The patient is very receptive of the procedure. However; the Patients Americanized daughter is not corporative and have questions about the diagnosis and surgery and asking for second opinion etc. More family involvement when the cousin of the patient and wife comes in who has more authority than the daughter in their custom and takes the family dynamics further. A church Member will come to visit as they did not see the patient at church and learned that he is hospitalized. Background info The patient is an Nzema which is a sub group of the Akan people of Ghana in West African. Ghana was colonized by the British and a lot of descendants of slaves in this country trace their roots back to Ghana. Ghana was an important route of the slave trade. Nzema’s are mostly farmers generally these people live in the remote part of Ghana who have poor roads not have very limited or no healthcare access. They practice more complementary and alternative treatment. Therefore; having physicians’ perspective or diagnosis is to be accepted and respected since they are educated for it. No questions asked (Lynn, 2011)