Christina C. Olson RN, MSN Pamela Gonzales RN, MSN

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Text of Christina C. Olson RN, MSN Pamela Gonzales RN, MSN

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Christina C. Olson RN, MSN Pamela Gonzales RN, MSN Slide 2 Increased demand for nurses Shortages in clinical sites Shortages of nursing faculty Lack of facilities for classroom and lab instruction space. Increased patient acuity. Slide 3 Grant Funding Methodist Healthcare Ministries Goals Increase nursing faculty Develop new clinical experiences Increase student enrollment Increase number of qualified nurse in community. Slide 4 the art and science of recreating clinical scenarios in artificial setting. Jeffries, 2005 a strategy, not technology, to mirror, anticipate or amplify real situations with guided experiences in a fully interactive way. Lassiter, 2007 Slide 5 Blending tradition with simulation Varying learning opportunities Encouraging critical thinking Creating a safe environment Providing opportunities not always available like the RN role Be creative. Slide 6 Medical/Surgical nursing faculty were tasked with development of : High fidelity clinical simulation scenarios Using various scenario products Or developing them from scratch Specifying them to our course outcomes Specifying clinical grading tools, templates and agendas Slide 7 best outcomes occur when a theoretical framework is used for structure and integrated across entire curriculums. Starkweather & Karding-Edgren, 2008 Slide 8 SIRCI Training http://sirc.nln.org/ http://sirc.nln.org/ Laerdal training http://www.laerdal.com/us/ http://www.laerdal.com/us/ Audio/visual equipment training Slide 9 Quality Safety Education for Nurses Guidelines(QSEN) And the proposed targets for Acquisition of Knowledge, Skills, Attitudes (KSAs) in all scenarios. http://www.qsen.org/ksas_prelicensure.php NLN SIRCI guidelines Slide 10 Med./Surg. course faculty member. BSN Clinical Teaching Assistant also a graduate nursing student. Grant set-up Slide 11 Develop scenario templates from nursing clinical knowledge and experience. Tailor clinical situations/diagnoses to content theory taught in co-requisite clinical, typical diagnoses found in clinical area and incorporate competencies specific to course leveling. Write new or adapt existing scenario products (such as NLN or Elsevier). Slide 12 Develop scenario template..described in greater detail later. Develop daily student clinical grading tool based on clinical course tool but adapted to simulation experiences. Develop daily student clinical worksheets also based on those used in clinical setting. Develop clinical rotation schedule for the 15 student groups. Slide 13 Develop virtual patient medical records needed for each scenario, in keeping with adult medical/surgical, hospital records. Loading all student course tools on accessible Blackboard Vista learning modules. Slide 14 BBV pre-work which contains: Required-directed reading/videos. Pre-worksheets to be completed Simulation specific learning objectives Simulation specific daily grading tool. Orientation to San Antonio Hospital Simulation Experience Orientation to roles assigned. Slide 15 Role of the Nurse Concepts Objective Performance Criteria SIM Day 1 Osteo Client Date ______ SIM Day 2 CHF Client Date ______ SIM Day 3 Bowel Client Date ______ SIM Day 4 CVA Client Date ______ Provider of Care Nursing Process Uses patho-physiology and psychosocial theories to explain complex medical surgical health care need and treatment response across the adult life span. Demonstrates in a plan of care, psycho-social, developmental and cultural factors which impact the family and client with complex medical surgical health care needs. Performs a systematic physical, psycho-social, cultural and developmental assessment on the simulation client. (10 pts) Correlates patho-physiology and psychopathology with assessments and establishes nursing diagnoses for the simulation client. (10 pts) Develop criteria based outcomes for the simulation client. (5 pts.) Plans nursing interventions for the simulation client based on client needs. (10 pts.) Therapeutic Nursing Interventions Demonstrate the appropriate use of cognitive, psychomotor and communication skills in the implementation of therapeutic nursing interventions. Provides scientific rationale for therapeutic nursing interventions required by the simulation client. (10 pts.) Slide 16 Communication Demonstrates the appropriate use of cognitive psychomotor and communication skills in the implementation of therapeutic nursing interventions. Participates and communicates effectively with student peers during simulation. (5 pts.) Caring Demonstrates professional attributes of caring when providing nursing care to adult clients with complex medical-surgical health care needs and their families. Demonstrates comportment to all fellow student members involved in the simulation experience. (5 pts.) Teaching/Learning Process Implement a teaching and or discharge plan for promotion of health maintenance, rehabilitation and restoration of health. Determines teaching needs to address simulation client/family learning needs. (5 pts) Critical Thinking Uses nursing process and critical thinking skills to prioritize and organize nursing care of clients with complex medical-surgical healthcare needs. Prioritizes nursing diagnoses for the simulation client. (5 pts.) Therapeutic Modalities Uses therapeutic modalities to promote adaptation for adult clients with complex healthcare needs. Coordinator of Care Communication Uses therapeutic modalities in collaboration with the interdisciplinary health care team, to promote adaptation for adult clients with complex health care needs. Documents simulation clients prescribed therapeutic modalities in daily careplan kardex. (5 pts. ) Documents significance of simulation clients diagnostic finding, correlating them to underlying patho-physiology. (5 pts) Uses appropriate medical terminology and charting technique in communicating simulation client data. (5 pts.) Slide 17 Therapeutic Modalities Uses therapeutic modalities to promote adaptation for adult clients with complex healthcare needs. Coordinator of Care Communication Uses therapeutic modalities in collaboration with the interdisciplinary health care team, to promote adaptation for adult clients with complex health care needs. Documents simulation clients prescribed therapeutic modalities in daily careplan kardex. (5 pts. ) Documents significance of simulation clients diagnostic finding, correlating them to underlying patho-physiology. (5 pts) Uses appropriate medical terminology and charting technique in communicating simulation client data. (5 pts.) Critical Thinking Utilizes community resources that assist clients and families in adapting to complex health care needs in collaboration with the inter-disciplinary health care team. Designates appropriate community resources and referrals in the daily clinical worksheet. (5 pts.) Caring Demonstrates the advocacy role of the nurse in caring for clients with complex health care needs and their families. Identifies key attributes of the advocacy role in caring for simulation clients and their families during de- briefing sessions. (5 pts.) Member of Profession Caring Demonstrates accountability and responsibility for the quality of nursing care provided Demonstrates accountability and responsibility during clinical simulation day. (5 pts.) Reflects a professional image in dress and manner during clinical simulation day. (5 pts.) Critical Thinking & Communication Identifies political, economic, ethical and legal issues associated with the nursing care of clients with complex health care needs. Communicates external issues impacting the simulation client/family health care needs during de- briefing sessions. (5 pts.) Maximum Points Possible 120 Accumulated Points Daily Numerical Grade (caluculated by ration/proportion) Slide 18 In the Beginning Pediatrics 4 Scenarios developed Acetaminophen Overdose Asthma Pyloric Stenosis VSD Developed by Simulation Grant Committee 15 Students in Simulation Scenarios ran 45 minutes Debriefing 1 to 1.5 hours Slide 19 Sim Newbie Slide 20 Current Scenarios Developed Fundamentals OB Pediatrics Medical Surgical Medical Surgical 1 Medical Surgical 2 Critical Care Currently 195 students in Simulation Scenarios run from 1.0 to 2 hours in length Debriefing run from 1.5 to 2.5 hours in length Slide 21 Critical Care Slide 22 Network Engineer Slide 23 Greet students Check Pre-work and grading criteria pertaining to role of Member of the Profession. Assign roles Run Simulation scenario either trended or spontaneous-script based Slide 24 Board of Nursing Requirements http://www.bon.state.t x.us/practice/position. html#15.26 http://www.bon.state.t x.us/practice/position. html#15.26 MHM Grant Requirements Simulation Faculty Meetings Simulation Coordinator Slide 25 Slide 26 Patient Hallways Slide 27 Modules on Blackboard Vista Setting: SICU Past Medical History: DM, CHF, HTN, CHF, Depression History of Present Illness: CHI S/P MVC Primary Medical Diagnosis: CHI with HA Surgeries/Procedures & Dates: Gallbladder removal Cognitive Activities Required prior to Simulation: Independent Reading (Lewis) Acute Intracranial Problems, including management of ICP monitor. ( pg 1467-87) Describe the pathophysiology of Cushings Triad pg 1469 Full Neurological Assessment pg. 1456-1461 Adult IV insertion and assessment Foley insertion Five rights of medication administration Adult assessment Documentation- Glascow Coma Scale pg 1476 Slide 28 Describe nursing considerations of a patient on a vent with an ICP monitor? What are the two types of posturing that can occur and describe how they appear? What are the potential complications of a patient with an ICP monitor? What is the normal range for ICP and CPP? What daily diagnostic tests would you expect to see ordered for this client? What are the primary nursing considerations for caring for a client with an ICP m

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