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SLS Implementation Guide

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1. 75 mL hr Drains and tubes Not applicable Wounds Not applicable ADLs Restrictions Standard precautions Assessments Alert and oriented x 4 Heart rate regular pulses 2 radial and pedal no peripheral edema Productive cough thick rust colored sputum Dyspnea upon exertion Bowel movement 1 day ago Urine clear using urinal at bedside Skin intact Patient independent but becomes short of breath with activity Frustrated about being in hospital son supportive Wife died 1 year ago ENS White blood cell count suggests infection Antibiotics started Assessment Recommendation Nurse s assessment Patient comfortable when resting Very independent gentleman Plan of care Monitor respiratory function Administer antibiotics and oxygen therapy Tests results pending Chest x ray just done Specimen for sputum culture collected and sent at 1450 Results are pending Orders pending completion None Other Son Jonathan is waiting outside the room while his father uses the urinal He can walk back in with you now This simulates an actual RN to RN report given when one nurse accepts patient care from another and leads the learner into the simulation scenario Patient Response Guide The Patient Response Guide offers questions comments and responses that the patient might make during the scenario Some responses are i
2. Primary diagnosis Adenocarcinoma bilateral lungs Secondary diagnosis Bone and lymph metastasis Copyright O 2011 by Elsevier Inc All rights reserved Na SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 11 Primary Challenge Learner assesses and implements care for a pediatric patient whose G tube feeding has become discon nected while respect ing the mother as the expert on the child s care Learner assesses and implements care for an older adult patient experiencing acute confusion related to a urinary tract infection Learner provides end of life and postmortem care while supporting a grieving family in a manner consistent with the patient and family s spiritual beliefs and cultural values 12 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Scenario Fundamentals 4 Fundamentals 5 Lm Fundamentals 6 Fundamentals 7 Patient Data Scenario Time Debriefing Time Jesus Garcia 28 years Male Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Lisa Rae 78 years Female Scenario Time 20 30 minutes Debriefing Time 20 30 minutes Nancy Gilbert 65 years Female Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Carl Rogers 67 years Male Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Scenario Concepts Con
3. li x os quum ea o be ESSE aa ade dal un Vade 28 RV 29 Initiating the Simulation EXtDETenco uou uou ard d otn ae oe dran Roe bob re eb e 29 Scenario Phase R he ge e y eva a Yee ek Ga n AAA 30 Scenario Phase o A 31 Scenario Phase UL U CO Sce ra alan EE dona A 32 LD A o s xa a e EE ge ge 33 B a sl u E EE 33 Debrienno Retlection Guide ua uno d brote EERE ocn A der ood d dod aa dieu on a 34 Guided Discussion SOL e e neces dara ct bara ad d c ad ir dod CERE dU V USE 35 Guided Discussion Nursing Diagnosis 35 Guided Discussion Patient Teaching ee Ne ert deb ed e SES 36 Guided Discussion Growth and Development 36 Guided Discussion Culture and Diversity aprisa E wee Race qs de d 36 Debriefing Final NOUS 6 04 ace gens rich Ec e 7X7077 37 DM A as 37 Student a suena d aras rn acd adt e pra m a rs oa 37 Ee IRCSOULCES ama asas aces Ea 7 7 39 vii Electronic Medical Record reversa YEE OR ER Pd RESO X E ROLE ERES 38 IMC TO s sr uri e sc eee EE EE ica ao esas 39 Nutsido Plov EE 39 Medicati n RECOrdS os decine xo dante reso roedor rada b iia Eg 009009 40 NOS erase 777 41 BEE e NEE EE EE Oor 41 Physician s Progress
4. 104 sen eA pue 5 Ajiuejuened pue esnjedxe jesuo YIM eouepi oe juaJino 1999 peseg o2uopi 3 Sp U pue sanj eA saguaJajald sjuened 104 0 48 uo peseq pejeuipJooo pue ejeuoissedujJoo ul Jeued pue o41u09 jo e2Jnos y se ubis p Jo juaned ay aziubogay 9Je2 2 S l u dulo2 NASH pe ejoy SUOIUSAJO U WOJWOD E9150J ooeuJueuQd UON desis pue say Aypiqouup AIqO SUSIBAH JeuoSJod uoneululz uoneJp H 6 pue UONL N S IA Q SAIISISSY 0 jou SI ING sepnjoui ISO pajejay Ajrep jo saniAyoe jo eoueuuojied ay l eouejsisse pue HOJWOD 1 ANY 44VY2 DISVA 1 9 eX319N suoneJeype uyeeu Bulibeueu pue enuajod ysi juaned BuronpoyJ Hojuioo pue ales BulplAoid Aq ss ull M pue yyesy eorsAud sejououd esunu Sy A119931NI 12190 10ISAHd AMOO31VO eX319N 14 ON 44V9 DISVE ALIHO31NI IVOIOOTIOISAHd S p JU0I I1IGNY uonen eA 3 Copyright O 2011 by Elsevier Inc All rights reserved 62 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 389 JO uinnunuoo v ssoJoe SUONBIPaU A ojejduioo pue A ojeJnooy g 1505 Ssuoneoipoeuu Buisn jo jejes ay uoneounuepi juened jo oejnooe y 0 s e09 jajes 3uaneg jJe
5. Initiating the Simulation Experience Orientation Role assignment DEBRIEFING Y Describe the setting Describe the simulation experience Review simulator function Assign participant roles Provide report FE Em ur En El RESOURCES DEBRIEFING v RESOURCES v 4 PREVIOUS Screen 07 of 19 NEXT e Complete permission to video consent Orient to simulation environment e Assume the role of the primary nurse secondary nurse patient s physician patient s son and observer s Obtain report and collect essential patient care information e Simulator Operator s Manual e SLS Implementation Guide Institutional protocol if available IFE Participant Role Badges FHB observer Evaluation Rubric IFE Patient Response Guide IFE Additional Participant Response Guide s B RN to RN Patient Report 4 PREVIOUS NEXT gt Certain ground rules should be established with students before beginning the clinical simulation experi ence The facilitator should reinforce that the simulation environment is a safe and positive environment for students to practice their skills It is essential to make students feel comfortable in simulation and acknowl edge the possibility that they may make mistakes Remind students that it is better to make a mistake in simulation and learn from the experience than to make a mistake with a real patient with the potential of causing harm Ta
6. jeninw uoneorunuuuJoo uedo Bulla soj SulE 640155 pue Sulsinu ulu A AR H uonoun J uomnejoqej o pue Speeu pue senj eA saguaJajald 5 uened 104 0 48 uo paseq pejeurpjyooo pue ejeuoisseduuoo ul Jeujied pue 041009 jo asnos y se eeuBisep Jo juaned ay aziubogay 9Je2 paJojua juaHed S l u dulo2 NASH pe ejoy UOISIAJIOGNS wee seul diosipa u ym UONBJOQqe Jo 3918 Jo AUDUDUOH 1499002 Duo SIUBIN JUanNed uoneynsuo oonoeJg 1ueujeAoUduu Neno jueujeAoJduj eoueuuojJiod jueujeDeue N ese Kunoes uoneuuoju AjeguepuuO senuoug DUIUSIOEISZ s nillq suods n pue siybBiy eBba7 Koe9OADV jueuieDeue A Jo 51090 uoneDeled ABojouyoes uoneuuoju S AHQ H Q SOUPAPY 0 Dau jou 51 q s pnioul juajuoo pajejoy leuuosJed a es yye y pue sjeujo jueonubis A mue sjuaned 193 0 1d o Bulnes eJeo ay seoueuue jeu Hulsunu Bunoeurp pue 34 JO LININIODVNVIN 1 8 9 eX319N JeuuosJed aJes yyesy pue sJeujo jueo1nubis A mue sjuened 398 0 d o Japo ui Dunes lenijep Sued ay seoueuue ey Hulsunu pue Aq s wo9 no juened jo ay sejououd sinu Sy LNSIAINOHIANS SHVO 31193443 ANY 34VS AHOO31VO eX319N 3YVI 40 LN3A39VNVIN LN3
7. 83 30 34 14 900 Laboratory Reports section because the EMR only reflects the time leading up to the clinical RE a simulation experience Laboratory results which ya are reported during the simulation scenario can be communicated by the facilitator verbally via a telephone call to the primary nurse or in a printed or projected laboratory result format The facilitator can reinforce the interpretation of patient laboratory report data before during or after the simulation scenario to enhance student understanding of how results relate to the care of the patient The facilitator may ask students to report normal ranges for laboratory values and give suggested rationales for abnormal findings DIAGNOSTIC REPORTS Results of radiologic tests and other special diag amp e nostic studies can be found under the Diagnostic m eener Reports tab Types of studies include chest Pc Carlos Gor MD X rays magnetic resonance imaging and comput TIT erized tomography scans Diagnostic reports 55 Supine film shows right upper lobe opacity with mild atelectasis Right and left lower lobes exhibit mild atelectasis Cardiac size vvithin normal limits for age and vveight Narrowing in the distal trachea cannot be modified by the student Diagnostic reports requested during the clinical simulation experience will not be found here because the EMR only reflects the time leading up to the clinical simulation experi
8. Hand Hygiene 3 men Performance Checklist Parenteral Intravenous Therapies Simulation Center Resources Open Gloving 1 m Student Challenge i Oxygenation R Feedback Open Gloving 2 ES EMR Hand Hygiene 1 _ Nutrition Personal Protective Equipment 1 Acknowledgements Elimination e Video Demonstration Personal Protective Equipment 2 Course Updates zd 77 Mobility Immobility pe Personal Protective Equipment 3 Skin and Wound Care 2 Sterile Field 1 of Surgical Patients m Sterile Field 2 As seen in the above set of screen shots the Skills Drills library is accessed from the SLS Home Page Inside the library is organized by core topic areas Within each of the topic folders is a list of available Skills Drills A uniform set of resources is available within each drill folder Infection Prevention and Control Medication Administration Hand Hygiene Medication Calculations Open Gloving Oral Medications Personal Protective Equipment Topical Medications Sterile Field Ophthalmic Medications Isolation Procedures Otic Medications Nasal Instillations Hygiene Rectal Suppositories Bathing Inhalers Oral Hygiene Injections Denture Care Various Meds Routes Back Care IV Fluid Containers Perineal Care IV Bolus Occupied Bed Making Various IV Routes Vital Signs Parenteral Intravenous Therapies Blood Pressure Initiating IV T
9. If oxygen is administered but the head of bed is not elevated Maurice s oxygen saturation level will increase and his dyspnea will decrease in correlation with the oxygen flow rate However dyspnea will not resolve until the head of bed is elevated Vital signs will reflect mild hypoxia If oxygen is not administered but the head of bed is elevated Maurice will experience only a slight improvement in his dyspnea He will communicate in short phrases only Vital signs will reflect hypoxia If oxygen is not administered and the head of bed is not elevated Maurice will experience worsening dyspnea He will communicate in two to three word phrases only Vital signs will reflect hypoxia Expected Student Performance 1 Evaluates patient s response to interventions 2 Monitors patient closely 3 Provides emotional support to patient and son 4 Documents all findings interventions and patient responses End the scenario 4 PREVIOUS NEXT gt Copyright O 2011 by Elsevier Inc All rights reserved SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 3 DEBRIEFING GIMULATION LEARNING SYSTEM Oxygenation and Hygiene ESTA ceuernc v PREPARATION DEBRIEFING e Debriefing Procedures e Debriefing Reflection Guide e Guided Discussion Questions e Guided Discussion Nursing Diagnosis e Guided Discussion Patient Teaching e Guided Discussion Growth and Development e Guided Discussion Culture a
10. Resources included in this packet are marked with an icon MBE throughout the module for quick reference o Staging Instructions Patient Identity Band RN to RN Patient Report Patient Response Guide Additional Participant Response Guide Participant Role Badges Observer Evaluation Rubric Algorithm Quick Card Performance Checklist 4 PREVIOUS NEXT gt Copyright O 2011 by Elsevier Inc All rights reserved A E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 19 Following the review of materials and practice session determine how the simulation scenario will be scheduled and managed with all students For example you may choose to run each scenario with small groups of 4 to 5 students with assigned roles or you may prefer to run a simulation scenario with a few stu dents while projecting the real time simulation to a classroom using audio visual equipment Some facilita tors may choose to run the simulation scenario with their designated clinical groups However you choose to implement the simulation scenarios this should be determined and communicated to students before ini tiating the simulation The Facilitator s Packet is a printable PDF file designed to assist facilitators before and during clinical sim ulation and includes information needed to prepare the setting communicate important information to stu dents and evaluate student performance The Facilitator s Packet can be d
11. Safety and Infection Control d Health Promotion and Maintenance Psychosocial Integrity Basic Care and Comfort Pharmacological and Parenteral Therapies Reduction of Risk Potential Physiological Adaptation PSYCHOSOCIAL INTEGRITY For each of these areas evaluation criteria and expected activities are detailed Information regarding the related QSEN competencies and national patient safety goals is also included For ease of use the Observer Evaluation Rubric should be printed out and provided to the student to write on during the scenario If desired each student may be assigned only one or two competency areas in order to help narrow the focus of their observation The facilitator should encourage observers to share the results of their observations during the debriefing session Algorithm Quick Card Algorithm Quick Card Thursday 1600 Maurice Arviso MR 7736871 Initial settings T Ar BP 132 72 P 100 ta lecreased oxygen saturation elevated temperature crackles in lung fields 3 Nome urine spilled on floor an 4 Utilizes therapeutic communi aon Y address patient concerns 9 Sat room air Heart See Regular Lung sounds Crackles bilaterally Abdominal sounds Pulses 2 Normal Patient states 71 used the urinal transition after 5 minutes T 101 6 F 38 7 C 142 80 P 108 RR 30 O Sat 86 room air Patient states I m sorry about the mess deep breath I m so sed deep bre
12. deep breath Am going to die here too deep breath Oxygen 3 L min via nasal cannula 02 Sat 91 feel a little better deep breath but still can t catch my breath deep breath Oxygen 4 L min via nasal cannula O2 Sat 9496 Il can breathe much better now Lam so sorry about the mess made but want to be able to use the urinal myself 1 don t want to be a burden to anyone Do you think I will be able to go home am afraid that will have to go to a nursing home want to be able to take care of myself haven t been able to spend time with my grandchildren because of this cough Can they catch it Maurice s shortness of breath will improve with increases in the oxygen flow rate However oxygen saturation will not rise above 9196 unless the head of bed is elevated Oxygen 2 L min via nasal cannula O2 Sat 8896 feel a little better with the oxygen on deep breath but it s still so hard to breathe deep breath Oxygen 3 L min via nasal cannula O2 Sat 9096 That oxygen is helping some deep breath but it s still so hard to breathe deep breath Oxygen 4 L min via nasal cannula O2 Sat 9196 1 feel better but still can t really catch my breath deep breath Is there anything else you can do to help me breathe easier deep breath Maurice will have increased shortness of breath until oxygen is titrated to 4 L min or greater
13. give away the scenario Preparing the Setting The Preparing the Setting section contains a reference copy of the scenario specific Staging Instructions including equipment props medications and facilitator s set up actions Please see detailed information about Staging Instructions in the Facilitator s Packet section of this guide on page 19 Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 29 2 SCENARIO a SIMULATION LEARNING SYSTEM Oxygenation and Hygiene PREPARATION SCENARIO Y _ Initiating the Simulation Experience Orientation When students arrive on the first clin ical simulation day it is important to provide them with an orientation to the human patient simulator and its functionality the equipment available in the room and the surrounding environment This should be individualized based on your setting and your stu dents familiarity with the simulation environment students who are new to the simulator will need more time for orientation than more experienced stu dents Students should be given a clear idea of the general activities they will perform during any simu lation For example they should be prepared to assume a role receive report review the EMR and begin to provide care to the patient while following the steps of the nursing process PREPARATION
14. Access List There are currently 6 enrolled users low Name Username Rights Title Teams Gibson June Jgibson Students Student Markman John jmarkman Students Student Mason Cheryl cmason Students Student Oliver Mark cmason Students Student Pearson Bonnie bpearson Students Student Reynolds Jennifer jreynolds Students Student Save Cance 6 Additionally you may restrict access to a resource by assigning a password in the Access settings Be sure to communicate this password to students so that they will be able to access the resource 7 Click Save Copyright 2011 by Elsevier Inc All rights reserved A s SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 51 GRADEBOOK Evaluation of students work throughout the SLS is managed using the gradebook of the Evolve Learning Management System You may access the gradebook using the Tools menu under the Group Management section of the Course Toolbox Group Settings e fpsteM nagement General Group Settings Repository Files Manager Tab Settings Backup Restore PIN Enrollment Settings Import Wizard Environment Variables Export Wizard Data Maintenance Group Management Gradebook Roster Teams Attendance You will be presented with the Evolve gradebook setup wizard when you first access your gradebook You may use this tool to custom
15. Crackles may be caused by the sudden re inflation of alveoli that have collapsed due to the pneumonia or disruption of the passage of air through the small airways caused by the pneumonia Your Response 6 Click OK after you have graded all responses You may return to an activity and assign or revise grades at any time 7 Return to the Assignment window to continue grading other assignments Click Done when finished You may also grade individual assignments within the Pre and Post simulation Learning Resources folder of each scenario Simply select Utilities from the menu beneath each activity GRADING STUDENT DOCUMENTATION IN THE EMR The process for grading EMR submissions is the same as grading other activity submissions However if a student has submitted a scenario s EMR more than once remember to grade only the most recent submission Copyright O 2011 by Elsevier Inc All rights reserved 55 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS ALIYDALNI TVIDOSOHIASd v 49NVN INIVIN GNV HLIVSH 1 NOILOAANI GNV AL33VS INZINNOMG AN 4 34 V9 4 ANV 44VS 2 J3YVI JO ININIIOVNVIN INZINNOMG AN 34 VI 341193333 ANV 33VS L Duunp uoissnosip ul ajedionied pue yOeqpss epi oJd o suoneAJesqo asou ST 1409 pasu v yolym ul seaJe pue jam p uLoH d sjuedionied yolym ul seoJe 9joN uolenys au jo juawsbeuew sjuedionied ay
16. Genitourinary Reproductive Musculoskeletal Integumentary and Psychosocial Any assessments completed during simulation should be documented in this section by the student Student learning activities using assessment data include identifying abnormal findings or trends in assessments Safety amp Hygiene Patient safety 1s paramount in any clinical setting Students must document the fall risk and basic safety measures implemented This interactive page also details interventions related to patient hygiene and comfort Restraints For simulated patients who have restraints ordered students should use this interactive flow sheet to document the restrained patient s care Students should ensure that the patient has the restraints removed at appropriate intervals and has been offered nutrition and toileting that alternative clinical activi ties have been offered and that the neurovascular status of the restrained area has been documented Rules and regulations regarding the use of restraints in the clinical setting and the impact of restraints on patient s rights are continually changing the EMR reflects the current practice recommendations at time of publica tion Suggested learning activities include asking students the rationale for these changing regulations and how proper documentation can ensure that the rights of restrained patients are protected MEDICATION RECORDS d Man Beet Hien Den Ern A In thi
17. Learning Resources p Scenario 9 Mary B t lal Post simulation Learning Resources la Scenario 10 Boyd D Nc M RN to RN Patient Report Algorithm Quick Card Scenario 12 Lillian C Observer Evaluation Rubric la Multimedia Resources GIMULATION LEARNING SYSTEM Fe Em unm v Oxygenation and Hygiene SCENARIO Y DEBRIEFING RESOURCES Y PREPARATION Y Scenario Overview Screen 01 of 19 NEXT F PE Purpose To provide students with the opportunity to assess plan prioritize and implement nursing care for a patient experiencing dyspnea and loss of independence Overview Maurice Arviso is a 60 year old Native American male directly admitted from his provider s office to the inpatient medical unit with community acquired pneumonia Maurice is determined to maintain his independence and dignity and refuses assistance with personal care even though he experiences shortness of breath with any exertion Just before the scenario begins Maurice attempts to use the urinal independently and spills urine on the bed and floor In the process he accidentally pulls off his nasal cannula which falls out of his reach He is frustrated and embarrassed and soon becomes dyspneic without his oxygen The scenario takes place on Thursday at 1600 During this scenario students will have the opportunity to assess plan prioritize and implement nursing care for a patient experiencing dys
18. NODIS carus qe rb s danaa oy EE PURA ERREUR 4 L 0011107 INE CICER EE SE Bd E ta nd odis 42 Diagnostic te hee aad l E EUER dor de EU Ye d ER ee d 42 1011 T CU ES 9S nuera ais Sd dame Medie 43 Fir ul ll D 43 o E d x e EE EE eos 43 galo IN o ia uo az TT 44 Emerence y e meds eR des euo 777 7 iu 7 EE ER te Patient Educatlofl RE rrr eas 771777 Ja 1151050111 r obas x EC dI RM ERE Bd 45 COMNSCING P r 45 SIMA TES Asa pod ob ee eae et 45 Usine Student Faculty and Evolve Resources e be REO EU Lace Rare dx Ra 46 Pre simulation Learning Resources Rabba Ee dek Oe n 46 Post simulaton Learni o RESOURCES randstad EROR e ned as be Ss 4 Activating and Deactivating Student Resources 48 Sic A ahaa soa oot aaa eee ese he ees 21 Grado A55 pita e ERRORS 7 77 7 bg 32 Grading Student Documentation in the EMR ER dd dax xab bd 3 RES SE SLS Observer Ee ARA e EE 25 viii Introduction In today s health care climate nurse educators are faced with the ever increasing challenge of providing optimal clinical experiences for their students that truly reflect the realities of i
19. Nursing Grand Valley State University Grand Rapids Michigan Madeline Lisa Lassche MSNEd RN Clinical Instructor College of Nursing University of Utah Salt Lake City Utah Andrew Siegel BS SN University of Minnesota School of Nursing Minneapolis Minnesota SLS TESTING SITES Drexel University College of Nursing amp Health Professions Center for Interdisciplinary Clinical Simulation and Practice Philadelphia Pennsylvania Southeast Community College Department of Health Occupations Lincoln Nebraska University of North Carolina at Chapel Hill School of Nursing Clinical Education amp Resource Center CERC Chapel Hill North Carolina Brief Contents LOLOLO suyi dt sis 1 he SiS Dinara o ao Ee o TIED o b s ra a s n 3 Simulation Learning System Recommended Protocol q SiS SG IDEM xn ad x b es ua ees 5 ODO AA 10 SLS Implementation Module ada dadda as d ed aci xU sar 16 IM ECCO treo zara b ea eee ee ads TIT 17 2 Ci ATP 29 DN RP 33 M clue as aboy axsa so xb demand swede ed bb 7 Electronic Medical RECOM ud moto d doa der CR pl EE d d acd xurma a 38 Using Student Faculty and Evolve Resources 46 SLS Observer Evaluation Rubric ERR RE oe ada SC do CR 5 Detailed Contents rte e a prenda Hea da acosa so eee wae pes dad 1 LL Homo C 3 Simulation Learning
20. System Recommended Protocol eu rociar e RC C R 4 Does dl ED il ee A weenie ae Oe oe Seca EE 2 SLS Skills Drills Recommended Protocol 24 422 239 oe dena m dee e EEN ed 5 q ls n 77P77 7 777 6 Skills Drills St dent VIO setos SE EE obs dk sete ea ddr bache dub de eae he ddr 7 Skits ea e Ae EE 5 9 9019 pened d r GOR Ud wb dip AUREUS SE ded 8 211117 US DANS coe heed Gd os ME e da are zal Bee eee bb 10 EQ AM 10 SLS pi ii ti OlL OdU 2456444 tee aaa oxusalar bb 16 NOA 77 7774 17 E SE ER E E e E 17 E ordan OBIECHUE S sos ee heehee aa g lm Pales PE Ur eee wee MG daa dE 18 I MD e dE et EEO ee s r aad E 18 Prepare VOUISOIE ie da E 18 Fu lilik m m o oa ee a an s s 19 AAPP 19 Sarme ceket o 19 22 ISN to RIN Patient Report tots ye Vae hide e aded aro VAL aod ae n 23 Patent Response Guide debe cee meade aped Edd vd qM pd a anal o 23 Additional Participant Response Guides 24 Participant dd BC S sida wus e par WEE EE hes 25 Observer Evaluation RUDTIC 2 cud deca na iradad ade dan VO EO EHE LA Ren o a 26 Pie omni OMmCK Card a a oe oe es e ra ara gel ar ya do eee 26 Rertotimancs EE 1345606 a ia sol y lan de ae les diodos 27 Prepare U L so d on eu ol l na oo pened s ES 28 1001111177
21. address and telephone number emergency contact insurance details admission consent and information about whether or not the patient has an advanced directive This information cannot be modified by the student Suggested learning activ ities may include asking the student to review the patient s insurance information to anticipate any limitations or challenges for patient care access after discharge CONSENTS Consent forms for blood transfusions and other diagnostic or surgical procedures are provided in the Consents tab Consents cannot be modified by the student in this section but some scenarios require a blank consent form to be printed out by the facilitator and provided as a prop during the scenario in these cases the form is available from the Preparing the Setting screen or within the Facilitator s Packet Learning activities related to consents may include discussions related to the legal implications of obtaining consents SIGNATURES This page is simply the electronic signature page for health care providers who have previously recorded data on the medical record 45 GIMULATION LEARNING SYSTEM MRN 7736871 Room 60 H Save 2 Download E Submit Restart Log off 233 Age Patient Maurice Arviso Gender Male Weight i identification Demographics Bs Authority for Admission a Flow Sheets A Medication Records A Nurses Notes Orders M Physician s Progress Notes A Laboratory
22. bed and floor In the process he accidentally pulls off his nasal cannula which falls out of his reach He is frustrated and embarrassed and soon becomes dyspneic without his oxygen The scenario takes place on Thursday at 1600 During this scenario students will have the opportunity to assess plan prioritize and implement nursing care for a patient experiencing dyspnea and loss of independence Recommended scenario time limit 20 25 minutes Recommended debriefing time limit 20 25 minutes Staging Instructions The physical simulation environment must be conducive to learning One primary purpose of simulation is to engage students in a challenging realistic situation and to allow them to interact with the physical envi ronment as well as the patient when managing the situation Maintaining an organized and well equipped physical environment will facilitate learning and enhance knowledge transfer to the clinical setting The SLS Home Page provides a link to Simulation Center Resources which include many resources that may help you in planning and preparing the physical simulation environment Simulation labs may be equipped with human patient simulators created by different manufacturers with varying functionalities Facilitators should make every effort to orient themselves to the particular human patient simulator used in their own simulation laboratory and gain mastery of its functionalities and techni cal operations It can be e
23. better deep the Sat 84 room air elevated tient states Help T 101 6 F 387 C ge 134 78 P2105 RR 28 Oz Sat Patient states I feel a little better with oxygen on dee best bt s so hard kim breathing worse deep breath but 1 still can t catch my breath breath 1 94 4 Limin via breath call doctor deep breath RR 32 Sat 87 toom ar air atent states At least deep breath I m not eam deep breath but still can t breathe deep breath Debriefing The Algorithm Quick Card may be accessed from several locations e The Facilitator s Packet for the scenario The Scenario Phase I Introduction screen e The Algorithm Quick Card quick access icon 224 on the scenario header bar to the right of the scenario title The Algorithm Quick Card is color coded to provide a quick visual cue to the current simulation phase Take a look at the example above PHASE lis the assessment stage Phase I lists the initial patient settings and the expected student perfor mance PHASE is the intervention stage Any changes in the patient s state from Phase I are noted here along with the expected student performance for this phase The student s interventions during Phase II will affect which route the patient will take going into Phase III Copyright 2011 by Elsevier Inc All rights reserved qEE E A arx n
24. care unit PACU to the medical surgical unit for routine postoperative care Primary diagnosis Acute appendicitis with rupture Primary Challenge Learner conducts nursing assessment and care while managing and prioritizing multiple common unit distractions Learner receives a report from the PACU and assesses and implements nursing interventions for a postoperative patient with moderate surgical site bleeding The actual simulation scenarios may be accessed through the folder labeled Simulation Scenarios From there select the scenario you wish to open Copyright O 2011 by Elsevier Inc All rights reserved SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 15 PATHWAY TO THE SCENARIO Simulation Scenarios lad Scenario 1 Alice M lad Scenario 2 Bernadette 7 JScenario 8 Maurice A m Scenario 3 Samuel G Add Content Rearrange Settings Reports Utilities Delete Publish Scenario 4 Jesus G g Implementation Module Oxygenation and Hygiene ug SENO S Im zl Scenario 8 Documentation EMR Reference and document assessment findings and care given during simulation lad Scenario 6 Nancy G a Scenario 8 Concept Mapping gt R ai Creat t that add the patient s health state Scenario 7 R reate a concept map tnat addresses e patient s nea state d la Care Plan Constructor Scenario 8 Maurice A 8 Pre simulation
25. enhance realism Report To begin the simulation scenario provide report using the RN to RN Patient Report Detailed information about using the RN to RN Patient Report is found in the Facilitator s Packet section of this guide on page 23 Scenario Phase Introduction The Scenario Phase I II and III screens provide detailed information about the scenario This information is most useful if reviewed ahead of time by the simulation facilitator in order to under stand the pathways of the scenario It can be refer enced as needed during the actual scenario These documents provide a high level of detail in con trast to the Algorithm Quick Card which pro vides a visual overview of the scenario If the facilitator is both controlling and speaking for the manikin it is recommended that the Patient Response Guide and Algorithm Quick Card be printed for use at the control station and that the Scenario Phase I II and III screens be kept close for occasional reference if needed Phase I represents the initial contact between stu dent and patient During this phase the primary nurse enters the room identifies the patient and conducts a focused assessment With each sce nario the additional events 1n Phase I are tailored to the specific scenario The initial Physiologic State indicates the specific physiologic parameters PREPARATION v SCENARIO v Scenario Phase I Introduction DEBRIEFING v RESOURCES v 4 PREVIOUS Scr
26. jueujeDeue N sseu seidelay o suods M pajoadxaun solueu pouoH KBojoisKudoujed seoue equi 1 pue pin 90100 suwa s s Apog ui suoneJelv 0 pejuui jou sI nq sepnjour juejuoo pajejay Suonipuoo yyesy eoisAud Buiuejeauu all JO SIUOJYO Ul sjueged Jo e1e5 pue Buibeue v NOILLV Ld VOV 1V2919010ISAHd AHOO31VOSfS eX319N suoneJaye uyeoeu Bulibeueu pue enuajod ys 1uened BurionpoyJ Hojuioo pue ales BulplAoid Aq ss ull M pue yyesy feolsAud sejououd esunu oul 11H91 NI 1V2190 10ISAHd AMOO31VO eX319N NOILVLdVGV 1V2190 IOISAHd ALIJO3LNI IVOIOO IOISAHd 78 p3uoo ounqns uoneniEAz Copyright O 2011 by Elsevier Inc All rights reserved
27. library and assigns any of the recommended Skills Drills as prepara tion for the selected SLS scenario Additional Skills Drills from the library can be assigned as desired 3 Students access Evolve to view the Student Challenge including reading assignment the Electronic Medical Record and a Video Demonstration 4 Instructor prepares the skills lab environment following the staging instructions within the Instructor Overview Students arrive at the Skills Drills lab 6 Students review the Student Challenge and Electronic Medical Record and complete the drill challenge 7 Students reference the Electronic Medical Record during the drill to obtain patient care information such as orders and previous assessments Students record care provided in the Electronic Medical Record 9 Evaluation observer completes the Performance Checklist as desired Un OO Copyright 2011 by Elsevier Inc All rights reserved AE es 6 915 IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS ACCESSING SKILLS DRILLS SIMULATION LEARNING SYSTEM Implementation Guide amp amp Skills Drills Library Simulation Scenarios Infection Prevention and Control j j jg EMR User Guide Infection Prevention and Control i Hygiene D R Scenario Index a Hand Hygiene 1 _JHand Hygiene SCH Vital Signs 6 Skills Drills Library Sample Skills Drill Hand Hygiene 2 m Instructor Overview Medication Administration i Ge
28. n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 27 PHASE III offers two or more patient outcomes depending on which interventions occurred during Phase II Expected student performance statements are provided for when the student performs the appropriate interventions If the student proceeds down the wrong route the scenario can proceed directly to the debriefing stage The number of branches for any given scenario depends on e The complexity of the situation e The number of appropriate interventions and e The number of possible outcomes Vital sign data and patient presentation details are provided for all three phases of the scenario although it 1s not expected that students necessarily assess this data during all three phases Vital signs and patient details are provided so that the facilitator is able to program the manikin s and provide students with patient presentation details at any time the student chooses to assess the patient during the course of the scenario Expected frequency of vital sign assessment will be dependent upon the individual scenario Although the quick card anticipates the most logical student response during the scenario it is important that the facilitator remain alert to unanticipated student actions and adjust the simulator as necessary At any point the facilitator should be ready to manually change the parameters on the simulator to reflect the con sequences of a student s action In addition if the
29. nursing assistant health care provider visitors friends and or family members Badges may be cut out and provided as identification props for the scenario Like the armbands facilitators may find it useful to laminate the role badges s and store them with scenario specific Patient s Physician Patient s Son documents and materials for future use Secondary Nurse Copyright O 2011 by Elsevier Inc All rights reserved AE es 26 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Observer Evaluation Rubric Created for the students who are observing the SLS Observer Evaluation Rubric Observe the simulation scenario and assess the participants management of the situation Note areas in which participants performed well and areas in which they need improvement Use these observations to provide feedback and participate in discussion during debriefing Exemplars observed during scenario Opportunities for improvement NCLEX Client Needs Category 1 SAFE AND EFFECTIVE CARE ENVIRONMENT MANAGEMENT OF CARE simulation the Observer Evaluation Rubric helps student observers evaluate how well the primary nurse secondary nurse and other partici pant s meet or exceed expectations related to the core nursing competency areas These areas include SAFE AND EFFECTIVE CARE ENVIRONMENT SAFETY AND INFECTION CONTROL 3 HEALTH PROMOTION AND MAINTENANCE Management of Care
30. pouring warm solution into sterile container and immersing sterile gau Places disposable ax within reach of work area Folds top of bag to make cuff Applies gloves Removes existing dressing and disposes of gloves Performs hand hygiene and applies sterile gloves Picks up 1 layer of gauze wrings out any excess solution and applies gauze lightly to open wound After a few seconds lifts edge of gauze to assess for redness Packs gauze against wound covering all wound surfaces Covers wound with dry sterile dressing and towel Removes gloves and performs hand hygiene Documents care in the EMR Peripheral IV 18 gauge angiocatheter with saline lock to right forearm Comments Places pad under affected Prepares compress by pouring warm immersing sterile gauze Places disposable bag within reach of work area Folds top of bag to make cuff Removes existing dressing and disposes of gloves Performs hand hygiene and applies sterile gloves Picks up 1 layer of gauze wrings out any excess solution and applies gauze lightly to open wound Copyright O 2011 by Elsevier Inc All rights reserved Na 10 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS AssiGNING SKILLS DRILLS When assigning drills for the preparation of an SLS scenario the first step 1s to review the Skills Drills recom
31. provides a description of the patient environment to be encountered by the student along with a Recommended Time to Advance to Copyright O 2011 by Elsevier Inc All rights reserved A E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 31 the next phase The time required to advance may vary based on actual student performance The Expected Student Performance lists actions to be accomplished during the first phase of the scenario These expected performance statements correspond with the Performance Checklist Scenario Phase l Experience During Phase II the student must use the data collected during the assessment process and begin to plan and intervene with the patient Vital signs are included in each phase in the event that the student assesses vital signs at that time not implying that students must assess vital signs during each phase Depending on the assessment findings the student may need to conduct inter ventions such as calling the appropriate health care provider and obtaining orders for treatments administering medications or performing other nursing interventions Students will have the opportunity to implement nursing interventions and perform psychomotor skills including but not limited to patient assessment medication administration intravenous fluid administration oxygen initiation and monitoring catheterization PREPARATION v DEBRIEFING v RESOURCES v Scenario Phase II E
32. salivation increased swallowing report of nausea sour taste in mouth Related Factors r t il 3 2 8 Edit Biochemical disorders e g uremia diabetic ketoacidosis pregnancy esophageal disease gastric distention gastric irritation increased intracranial pressure intraabdominal tumors labyrinthitis liver capsule stretch localized tumors e g acoustic neuroma primary or secondary brain tumors bone metastases at base of skull meningitis Meniere s disease motion sickness pain pancreatic disease splenetic capsule stretch toxins e g tumor produced peptides abnormal metabolites due to cancer Situational Anxiety fear noxious odors noxious taste pain psychological factors unpleasant visual stimulation Treatment Related Gastric distention gastric irritation pharmaceuticals NOC Outcomes Nursing Outcomes Classification Suggested NOC Outcomes Nutritional Status Food and Fluid Intake Nutrient Intake Add 1 entries Example NOC Outcome with Indicators v Journaling After the simulation event students can be encouraged to practice self reflection by complet ing a journaling assignment If desired the journal question can be modified by the facilitator to reflect a particular style such as the journal format used during student clinical rotations After the student com pletes the journal entry it can be submitted electronically to the facilitator for evalua
33. section of the EMR is described in detail below Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS IDENTIFICATION The Identification page appears first in the EMR The patient s medical record number name room number gender age provider s name primary diagnosis secondary diagnosis allergies height weight and code status are listed next to a photograph of the patient These data cannot be modified by the student Using this information students should correctly iden tify the patient and validate the presented infor mation with the simulated patient especially related to patient allergies NunsiNG FLow SHEETS The interactive Nursing Flow Sheets section of the EMR contains nursing assessment and inter vention data beginning at the time of the patient s admission to the inpatient unit The flow sheets are organized according to the following sub categories Vital Signs Pain Intake amp Output IV Therapy Special Monitoring System Assessment Safety amp Hygiene and Restraints Students can document assessments they have conducted dur ing the scenario gaining practice that will lead to improved documentation skills transferrable to the clinical setting Codes for abbreviations are listed under the information icon 4 to the left 39 User Danny Witzofsky dwitzofsky Scena
34. the use of the o incentive spirometer and the importance of coughing and v ELSEVIER lt amp Elsevier All rights reserved x clinical events is essential to the safe care of patients in the clinical environment a skill that can be practiced in the EMR during clinical simulation ORDERS The primary health care provider s written orders are documented in the Orders section These orders begin at the time of admission and progress until the scenario begins Checking and interpreting orders correctly is a valuable nursing skill that ensures patient safety The facilitator should make sure that students access this infor mation when checking medication orders in the Medication Records and when implementing any nursing or medical interventions If the stu dent obtains any verbal orders during the course of the simulation scenario these orders can be documented on this interactive page PHYSICIAN S PROGRESS NOTES Physician notes or primary health care providers notes are displayed under the Physician s Progress Notes tab These narrative notes include the primary health care provider s description of the patient assessment along with the rationales for interventions This information cannot be modified by the student Suggested learning activ ities include the analysis of this information when determining the rationale for various orders such as medication changes treatment additions or the ordering of diagnostic te
35. vital patient information such as prior assessment findings medication administration history and provider orders Students also need EMR access in order to document their care As with the SLS scenarios all information recorded by the student during the skills drill can be submitted for instructor review See the EMR User Guide for more information For most Skills Drills a Video Demonstration of the related skill is available for student review These demonstrations are meant to serve as basic visual guides to the related skill For the step by step skill process students should refer to the textbook reading assignments included in the challenge SKILLS DRILLS INSTRUCTOR VIEW In addition to the student resources instructors have access to an Instructor Overview and Performance Checklist for each skills drill Copyright 2011 by Elsevier Inc All rights reserved SIMULATION LEARNING SYSTEM Ann Tran ender Female Save Download E submit jRestart D Log off Provider Name Primary Diagnosis Secondary Diagnosis Allergies Height Weight at admission Code Status 2963331 Ann Tran 811 Female 16 Susan Rogers MD Anorexia nervosa No known allergies 5 ft 4 in 92 Ib Full code Video Demonstration Settings Reports Utilities Delete Publish Moist Heat Compresses and Sitz Baths Step 08 Applying Compress Apply Compress and Check for Redness v Step 8 of 30 0
36. 1VO eX319N TIWILNSLOd ASIA JO NOILONGSAY ALIHO3LINI TVOISOTOISAHd Z p JU0I I1IGNY uonenj eA 3 Copyright O 2011 by Elsevier Inc All rights reserved 64 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS yd salduajadulo9 BJO uesb 01 02 gz eunf serouajeduio Ajajes pue AIS OLOZ 899 40 voneonp3 jejes pue Alileno jpd uejgise NY XSION 01021 0 0 0 8 50 WOJ OLOZ 8z eunr pe eujes S2 L NM X3 TON 0L0Z BuisunN Jo spieog Jo IDUNOJ JsjeobAjejesjuened jeuoneu Ajsjesjuemned DbJo UOISSIWULUOO UIOl MMdh OLOZ 8Z eunr sjeoo Ajajeg juerjeg Jeuonen 0OLOZ UOISSIWWOD jurof eu uonipuoo sau ned e ui seDueuo o asuodsa pue uoniuDooaJ 9 Log be1eus ejes juaned e se ag umo 1y ui jueuleA oAur oAnoe sjuened eBejnoou3 CL Log 61200 jajes 3uaneg jeuoneN 01 02 P el M 8J62 yyesy euundo jo ISM 9P 104 SAN eA pue jiuejuened pue esnjedxe jelu ym eouepi oe juana 1999 peseg o2uopil 3 Sp U pue sanj eA saguaJajald 5 juened 104 j2edsoJ uo paseq ag pejeuipJooo pue ejeuoisseduuoo ul pue o uos jo asnos y se ubis p Jo zu yed ay azlubogay 9Je2 paJojua jua9Hed S l u dulo2 NASH P El M
37. AN Professor and Associate Dean School of Nursing Southern Illinois University Edwardsville Edwardsville Illinois Patricia A Potter RN MSN PhD FAAN Research Scientist Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine St Louis Missouri June Thompson RN DRPH Winter Garden Florida Kristin Ulstad MN RN CCTN Teaching Specialist Simulation University of Minnesota School of Nursing Minneapolis Minnesota SCENARIO CONTRIBUTORS Gail E Armstrong ND RN CNE Assistant Professor College of Nursing University of Colorado Aurora Colorado Deborah Bambini PhD WHNP BC CNE Associate Professor Kirkhoff College of Nursing Grand Valley State University Grand Rapids Michigan Barbara L Cheuvront PhDc MS RN Assistant Professor Regis University Denver Colorado Dawna Egelhoff RN MSN Assistant Professor Lewis and Clark Community College School of Nursing Godfrey Illinois Nadine Cozzo Englert PhD RN Assistant Professor Robert Morris University Moon Township Pennsylvania Madeline L Lassche MSNEd RN Clinical Instructor University of Utah Salt Lake City Utah Annette K Orangio MSN RN Simulation Specialist Pensacola Junior College Pensacola Florida Marta E Suarez O Connor MSN RN Education Director Mary Ekdahl Smart Center for Patient Simulation Training amp Research Pensacola Junior College Pensacola Florida Jennifer
38. All rights reserved Primary Challenge Learner assesses and manages colostomy care while addressing a patient s issues with body image and sexuality Learner assesses and implements nursing care for a patient at high risk for falls and pressure ulcer development Learner assesses a patient with moderate respiratory distress and conducts sterile tracheostomy suction ing while maintaining contact isolation precautions Learner assesses prioritizes and manages care for a diabetic patient with a non healing foot ulcer and elevated blood glucose level Scenario Fundamentals Fundamentals 9 Fundamentals 10 Patient Data Scenario Time Debriefing Time Maurice Arviso 60 years Male Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Mary Bailey 30 years Female Scenario Time 25 30 minutes Debriefing Time 25 30 minutes Boyd Dubois 58 years Male Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Scenario Concepts Concepts Vital signs Assessment Prioritization Oxygenation Communication Hygiene Patient education Documentation and informatics Concepts Vital signs Assessment Fluid electrolyte and acid base balance Medication administration IV Patient education Documentation and informatics Concepts Vital signs Postoperative assessment Pain management Medictaion administration IV and SQ Postoperative care Do
39. At least deep breath I m not lying flat deep breath but 1 still can t breathe deep breath Maurice will have increased shortness of breath He will only be able to talk in two to three word idministered and the phrases If oxygen is NOT head of bed is NOT elevated Help deep breath breathing worse deep breath call doctor deep breath f dignity and privacy Maurice will express his gratitude If diani are maintained during care Thank you for helping me am usually very independent This is difficult for me dignity and privacy Maurice will express further frustration and embarrassment If di i are NOT maintained during care This is so hard don t want to be a burden to anyone I might as well just die if can t do things on my own Copyright O 2011 by Elsevier Inc All rights reserved 24 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Additional Participant Response Guide Additional participant s may be family members friends a physician or another person who is present either physically or by telephone during the simulation The Additional Participant Response Guide pro vides a script for the person assigned to the particular role Print out or copy the Additional Participant Response Guides and provide them to participants at the time of the scenario Family Member or Friend Student participants Additional Participant Respons
40. D DEACTIVATING STUDENT RESOURCES The SLS pre simulation and post simulation student resources described above are designed to enhance understanding and have a positive impact on learning outcomes All of these resources can be made available or unavailable to students at your discretion You should review and activate or deactivate the appropriate resources depending on your students knowledge base and level of experience with simulation 1 Navigate to the course folder containing the resource you wish to make available Scenario 1 Add Content Rearrange Settings Reports Utilities Delete Protect Content Publish Implementation Module Pneumonia Oxygen Delivery 7 Pre simulation Learning Resources 4 Post simulation Learning Resources y RN to RN Patient Report Multimedia Resources 2 Select Settings from the menu that appears under the resource title Scenario 1 Add Content Rearrange Settings Reports Utilities Delete Protect Content Publish Implementation Module Pneumonia Oxygen Delivery a Pre simulation Learning Resources a Post simulation Learning Resources RNZLO RNM Patient Report eports utilities delete la Multimedia Resources k Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 49 3 Select the Access tab From this section the Evolve Learning System allows you to r
41. Ew Gia am Applying Moist Sterile Compress Pick up one layer of immersed gauze wring out excess solution and apply it lightly to open wound and avoid surrounding skin In few seconds lift edge of gauze to assess for redness which indicates a burn _JHeat and Cold Therapy 1 Instructor Overview a Performance Checklist Student Challenge aJ EMR Heat and Cold Therapy 1 Video Demonstration SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS The Instructor Overview contains the same information as the Student Challenge along with the purpose of the drill a list of expected student outcomes and a complete set of staging Instructions When preparing the lab from the staging instruc tions either the simple set up or complete set up can be used The simple set up includes only the props and equipment needed for the completion of the specific skill challenge The complete set up includes all the props and equipment needed to create the full patient situation The complete set up can be used for a richer simulation experience The Performance Checklist is comprised of the student outcome list in an easy to use evaluation geared table A printed copy of the Performance Checklist should be made available for the desig nated evaluation observer instructor or peer The checklist can also be made available for student self evaluation Category Skin and wound care Student instr
42. Family History One son living and in good health wife died 1 year ago of breast cancer father died at age 55 of congestive Consents heart failure mother alive 1 sibling in good health Signatures Past Medical History Previous Colds and bronchitis It is worse in the winter when I m working inside and in my workshop Illnesses 1 seem to get bronchitis at least once or twice a year Contagious Mumps measles chickenpox as a chid none currently Diseases Injuries or Broken right arm age 9 no complications ELSEVIER SE gt the foundation for admission orders the facilitator can ask the student to provide a rationale for the admit ting orders based on the H amp P The facilitator may also ask the student to identify any abnormal findings in the report and relate these to the diagnosis and care of the simulated patient NURSING ADMISSION The Nursing Admission section is completed by the nurse at the time of the patient s admission to the inpatient unit Whether or not students will complete this section themselves depends on when the simulation is scheduled to occur during the course of the hospitalization That is if com pletion of the admission assessment section is a stated performance objective for the clinical sim ulation scenario students will be able to enter data However if the patient was admitted before the designated simulation scenario start time the section will have been previously complete
43. INNOMIAN3 33V2 3A1L93443 345 1 p JU0I I1IGNY 19A19SGO Copyright O 2011 by Elsevier Inc All rights reserved 58 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS uone ndod juaned ul jueJeuur su jajes jjuep CL Log be1eJ1s jejes juaned e se 9Jeo umo 11y ui sjuened eDejnoou3 CL Log SEL uo BunjnseJ uueu juened jo su v eonpes 6 JE05 SUONDSJUI p9jeloosse 3129 yyeauy JO su v eonpes 7 L09 Ssuoneoipoeuu Buisn jo Ajgjes v anodul uoneoinuepi juened jo ay eog S e09 Ajajes juerped Jeuonen 0107 p el s swa s s aJes yyesy jo jajes pue ay eAo4duui A snonunuoo o soDueuo sa pue uBisep o SPOUJOW jueujeAoJduui aen pue sesseooud eJeo jo sauoa no y JOJIUOW oj ejep asf jueuieAoJdui eno eoueuuojed enpiaipui pue SS U AR H Ulass uyoq yno sjepi oud pue sjuerned o uueu JO YSU eziuiuN JOJeS S l u dulo2 NASH pe ejoy 901 1 lES S1UIE S M 10 UORU A Lc JOJ3 Kjejes juaudinby jo asp sisdesy eso1B1nmg suonnesa g se diouug 0 peseg uoissiuisueJ suonneooeJgd 1 jo Bunloday sjene snonoosju pue snop ezeH DUIDUEH e ue geasuodsay ou bl u uejd AjunoeS uonuanalg Aun
44. LS 21 Standard Props and Equipment for All Scenarios Supplies Patient care equipment Additional equipment in or near patient room Hand sanitizer or hand Functioning bed washing station Extra pillows Telephone for provider or Universal precaution Sphygmomanometer interprofessional calls supplies clean gloves Stethoscope or student to Regular garbage bin sizes gowns masks face provide Biohazard garbage bin shields or goggles e Thermometer Linen bag or bin Saline flush syringes for IV flushes 2 Alcohol wipes Cardiac monitor Writing surface Cotton balls Oxygen source wall mount Pen and note paper or tank Calculator Oxygen flow meter Chair for visitor Nasal cannula and tubing Laptop or desktop computer Oxygen face mask with internet connection for the Electronic Medical Record Clean gauze squares Bandages Tape Scissors Box of tissues Bag valve mask e Suction equipment wall Peripads mount or portable Bed pads Sterile gloves in all sizes Supply cart optional for organization of supplies Medication cart with simulated medications see each scenario list for specific medications Depending on the type of human patient simulator being used and the type of equipment available in your simulation setting creative moulage may be necessary The Staging Instructions may specify a particular patient presentation such as type of wound or bloody discha
45. LS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Scenario Phase lll Outcome During Phase III the simulator responds to the interventions or lack thereof in a positive or negative manner resulting in the ultimate patient outcome The student has the opportunity to reassess the patient and evaluate the effectiveness of the interventions The Physiologic State and Situation Transition are also provided as in pre vious phases Expected Student Performance during Phase III involves evaluation of the inter ventions and documentation of the events in the EMR Once the student completes all perfor mance behaviors or if the student appears to be following an incorrect pathway and the patient situation deteriorates the facilitator may choose to state The scenario is over and proceed to the debriefing portion of the SLS PREPARATION RESOURCES v Scenario Phase III Outcome SCENARIO v DEBRIEFING v 4 PREVIOUS Screen 10 of 19 NEXT Physiologic State If oxygen is administered and head of bed is elevated T 101 6 F 38 7 C BP 126 70 P 98 RR 24 e Maurice states I feel a little better deep breath but I still can t catch my breath O Sat 89 2 L min via nasal cannula O Sat 91 3 L min via nasal cannula e Maurice states I feel a little better deep breath but I still can t catch my breath O Sat 94 4 L min via nasal cannula e Maurice states I can breathe much better now If o
46. Log off IMULATION LEARNING SYSTEM 7736871 Maurice Arviso Patient 233 Male 60 155 Ib Room Gender Age Weight Provider Patrick Cronin MD Code Status J Allergies i II code Identification History and Physical Chief Informant Chief Complaint History of Present Illness Allergies Family History Past Medical History Social History Current Medications Immunizations Review of Systems Physical Exam Impressions Plan Signature Flow Sheets Medication Records D Nurses Notes un Chief Informant Orders Patient il Physician s Progress Notes Chief Complaint Laboratory Reports i Shortness of breath fever cough producing rust colored sputum Diagnostic Reports History of Present Illness Consults Procedures R R E Patient presented today to my office with a chief complaint of fever chills and a bad cough He reports that the fever and chills started about 24 hours ago and that the cough has been present for 2 or 3 days At first the cough was nonproductive but it began to produce thick rust colored sputum about 24 hours ago Patient reports chest pain with the frequent cough Patient denies palpatations nausea vomiting or radiation of the pain Patient denies recent travel or exposure to illness History and Physical Nursing Admission a Surgical Reports Emergency Department Allergies Patient Education No known allergies Demographics
47. MULATION LEARNING SYSTEM e The folder named Simulation Scenarios contains an expandable list of scenarios e The EMR User Guide provides comprehen sive instructions for the SLS Electronic Medical Record for both faculty and student use Implementation Guide Simulation Scenarios e The Scenario Index lists each scenario that is currently available This grid will 3 EMR User Guide continue to expand as new scenarios become available g Scenario Index e The Skills Drills Library D contains a Skills Drills Library library of modules each focused on the demonstration of a single skill Each skills drills module includes set up instructions Simulation Center Resources for the instructor a mini scenario challenge with a corresponding EMR a performance checklist and a multimedia demonstration Ge Sample Skills Drill Feedback Send us your comments and recommendations for the SLS Acknowledgements e The Simulation Center Resources consist of select sites for purchasing equipment Course Updates locating resources to set up your lab finding support organizations and more This list will continue to be updated as new sources are identified e The Feedback folder provides two ways to submit your comments and recommendations e The Request a Scenario link gives you the opportunity to inform us of any specific scenarios that may enhance your particular curriculum The suggestions will be ro
48. NE and Kristin Ulstad MN RN CCTN ing questions at pivotal points during the sce gt 4 PREVIOUS NEXT gt nario During the Integration phase discussion is guided to link theory to practice and facilitate transfer of knowledge to the clinical setting and next patient encounter The Integration phase is also an optimal time to review any pre simulation learning exercises that students completed before the simulation experience Other important clinical skills and concepts can be discussed during the Responsive Inquiry and Integration phases The Guided Discussion section of the SLS described below provides suggestions for questions specific to the scenario Other valuable debriefing topics common to all scenarios include therapeutic communication professional communication teamwork patient safety quality of care considerations and documentation The Closure phase concludes the debriefing with the students final thoughts on the scenario and positive honest comments from the facilitator If the scenario was particularly challenging for the students the facilitator should be cautious not to offer false praise such as by saying Good job Instead the facilitator should offer an honest appraisal such as This was a difficult scenario and I appreciate your participation It seems like this was a good learning experience Copyright O 2011 by Elsevier Inc All rights reserved A E A arx n n SLS IMPLEMENTATION GUIDE FOR NU
49. OALS 1 Nurses Notes a Orders Physician s Progress Notes 1 Patient will verbalize understanding of unit 5 A Laboratory Reports 2 Patient will demonstrate use of call light Diagnostic Reports 3 Patient will demonstrate the correct use of the incentive spirometer SE 4 Patient will verbalize understanding of need to measure document intake and output ae 5 Patient will verbalize understanding of rationale for IV therapy lt Ji gt Nursing Admission i Surgical Reports GOAL ITEM TAUGHT PERSON CURRENT TEACHING LAST TEACHING INITIAL TEACHING a Emergency Department TAUGHT DAY LEVEL INIT DAY LEVEL INIT DAY LEVEL INIT n Patient Education qp Demographics A 1 Oriented to the unit P OF Thurs 3 po B i Consents Signatures 2 Use of the calllight P OF Thurs 3 BD 3 Use of the incentive p Thurs 3 BD spirometer 4 Use nf the urinal P Thurs 2 BD Y m a Ges Elsevier All rights reserved v gt education In addition patient teaching topics are covered in the debriefing guide following the scenario The facilitator may ask the student to provide a rationale for certain patient education topics or create a sample teaching plan including methods of delivery and expected patient outcomes Copyright O 2011 by Elsevier Inc All rights reserved A E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS DEMOGRAPHICS The Demographics section contains admission information including admitting diagnoses patient
50. REVIOUS NEXT gt PREPARATION v SCENARIO v DEBRIEFING v RESOURCES v Guided Discussion Culture and Diversity 4 PREVIOUS Screen 17 of 19 NEXT gt Native American Key Points 1 e Native American languages might not have translation into the English language e Nuclear and extended family are of paramount importance e Time is casual and present time oriented e Traditional health healers are often used Text Reference p 111 Reference Giger and Davidhizar Transcultural Nursing Assessment and Intervention 5 Edition St Louis 2008 Mosby 4 PREVIOUS NEXT gt Copyright 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Debriefing Final Notes 37 Students should be reminded that the details of the particular simulation scenario should not be shared with other nursing students this ensures that all students are given equal opportunity to experience clinical simu lation and that no student will have an unfair advantage In addition if your institution records the simula tion scenarios for student review during the debriefing session students should sign a permission form indi cating that the recording will be used only for educational purposes will not be shared with individuals who have not been directly involved with the simulation scenario and will be destroyed following review You ma
51. RSING FUNDAMENTALS Guided Discussion Questions The SES provides questions that directly relate to the scenario content for guided discussion during the Responsive Inquiry and Integration phases of debriefing These questions cover topics such as pathophysiology treatment options expected patient responses to interventions quality and safety indicators and protocols Suggested answers rationales from the textbook reading assignments and multimedia resources are pro vided to assist facilitators in leading discussion and initiating remediation Encourage students to openly share their responses to these questions during the debriefing session If students are chal lenged by a question encourage them to think out loud and collaborate with their peers to problem solve and arrive at the best answer Alternatively if debriefing time is limited the guided discussion questions may be utilized as a large group discussion in a lecture class shortly after the simulation event or assigned as homework immediately following simulation Guided Discussion Nursing Diagnosis Corresponding North American Nursing Diagno sis Association NANDA International approved nursing diagnoses and patient goals from your specific nursing textbook are provided for each scenario with page references included The facil itator may use these diagnoses as a guide when 2 asking students to identify appropriate scenario specific nursing diagn
52. Reports Diagnostic Reports Consults Procedures A History and Physical A Nursing Admission i Surgical Reports po 491 p Scheduled H 2 E Patient Education Demographics 155 Ib Provider Patrick Cronin MD Allergies Code Status 7 i Full code Name Maurice Arviso MEN 363 1 Room 233 Physician Patrick Cronin Mn E Pneumococcal pirzumoria Diaznosis 2 ICD 2 Procecure Code Telephone B Consents Last Name First Name Midde Name Age Sex Home 555 195 8901 Work Signatures 3230 E Logan Strect Dineth CO 0107 Mobile nme Address Apartmertf Unit y St ev Status Widow Races Nativo American Deckeround Religion Christian s User Danny Witzofsky dwitzofsky Scenario 8 Sim Day Time Thur at 1600 E Elsevier All rights reserved Name Lillian Chambers Informed Consent for Surgical and Diagnostic Procedures lacknowledge and understand that the following procedure s that has been described in general terms is to be performed on me Openappendectomy lunderstand that my condition has been diagnosed as MRN 7781324 Room 437 understand that if do not undergo this proposed procedure my prognosis is Potentially fatal lunderstand that the practical alternatives to this Acute appendicitis with rupture understand that the purpose of this procedure is To remove appendix and treat the i
53. S This protocol includes a variety of options for instructors to customize the simulation experience to meet the unique needs of their students Individual steps of the protocol may be modified as desired to maximize the use of the SLS in your academic setting 1 Instructor selects the appropriate simulation scenario using the Scenario Index and prepares for simu lation using the Implementation Module 2 Instructor schedules students for simulation Instructor activates student Evolve access to pre simulation activities as desired Reading Assignment Concept Mapping Pre simulation Exercise Pre simulation Quiz Skills Drills RN to RN Patient Report and Electronic Medical Record Students access Evolve to complete the assigned pre simulation activities Instructor prepares the simulation environment using the Facilitator s Packet Students arrive at the simulation lab Instructor orients students to simulation environment Instructor assigns roles and distributes the Participant Role Badges Additional Participant Response Guide s and Observer Evaluation Rubric 9 Instructor or student provides RN to RN Patient Report in written or verbal form to all participants 10 Instructor signals start of scenario and students engage in simulation 11 Students reference the Electronic Medical Record during the scenario to obtain patient care informa tion such as orders and patient data 12 Instructor progresses scenario using the Algo
54. SS SSE pue oueusos uorej nuuis ay 911GNY uonen e 3 19419590 SIS Copyright O 2011 by Elsevier Inc All rights reserved 56 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 14 0 TVWIIDOTOISAHd ALIYMDALNI TVOISOTOISAHd 8 TIWILNALOd 1SI4 NOILOn Q3 TVOISOTOISAHd 72 5114 4 TVATLNIAVA GNV IWOISO 1IOOVINAVHd TVOISOTOISAHd 9 JYOJINOI QNV JAVI 2158 TVOISOTOISAHd S pjuoo ounuqns uonenje 3 19A19SQO Copyright O 2011 by Elsevier Inc All rights reserved 57 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 5 jejes juaned e se 9Jeo umo 11y ui eAnoe sjuened eDeJjnoou3 c Log 6 4 Buouje uoneoiunuuuJoo Jo sseueAnoasje y Z 61200 A yes 3uaneg jeuoneN 010Z Bulyew uoisioep JJoddns pue jose 342p eBpajmouy eBeueui o ASoyouu pue uoneuuojJur esf soneuuojJu swa s s uyeou jo jajes pue ay eAo4duur A snonunuoo o soDueuo sa pue ubisap o spoujeuJ jueujeAoJduJi aen pue sesseooJd 9Jeo JO S8WODINO eui JOWUOW O ejep esf jueuieAoJdui Ajeno eoueuuoJied jenpinipul pue SS U AN H ulejs s uyoq uBnouJui sJepi oJd pue s u yed o uueu JO YSL ZIWIUIN jojes 81e9 juened Al lenb analyoe o Buryew uoIsiosp pareys pue 30edsoJ
55. Simulation Learning System Fundamentals Implementation Guide SN DYESS y ZA eS S IS WS Ze WS ADIOS AS D V S PERN E gt SS 77 pi E S NES INS LEINN N y 8 ME SN DR NPD e UY ASA E mig NN NS S NS SN UNS ELSEVIER ELSEVIER 3251 Riverport Lane Maryland Heights Missouri 63043 SIMULATION LEARNING SYSTEM FUNDAMENTALS ISBN 978 1 4377 2641 1 IMPLEMENTATION GUIDE Copyright O 2011 by Elsevier Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopy recording or any information storage and retrieval system without permission in writing from the publisher Permissions may be sought directly from Elsevier s Rights Department phone 1 215 239 3804 US or 44 1865 843830 UK fax 44 1865 853333 e mail healthpermissions elsevier com You may also complete your request on line via the Elsevier website at http www elsevier com permissions Notice Knowledge and best practice in this field are constantly changing As new research and experience broaden our knowledge changes in practice treatment and drug therapy may become necessary or appropriate Readers are advised to check the most current information provided 1 on procedures featured or 11 by the manufacturer of each product to be administered to verify the recommended dose or formula th
56. UNDAMENTALS 53 4 You will be presented with a list of submissions from all students Click Grade next to the student s User ID to view and submit a score for that student s response Scenario 8 Post simulation Exercises Utilities gt Submissions User ID Grade 100 pts Submitted IP Address View Delete Newton Chelsea cnewton 6 2 2010 4 50 45 PM 198 185 18 72 View Delete Newton Chelsea cnewton 6 2 2010 4 08 21 PM 198 185 18 72 View Delete Korte Jennifer jkorte01 5 30 2010 8 14 41 PM 66 90 11 100 View Delete de Sousa Marc mdesousa 5 21 2010 1 07 56 PM 70 141 63 190 5 After reviewing the response enter the points you wish to award in the Score field Scenario 8 Post simulation Exercises Utilities gt Submissions gt Grade submission by Newton Chelsea cnewton on 6 2 2010 4 50 45 PM C Hide Graded Items Points Awarded Points Missed Points Ungraded 30 1 Discuss the probable cause of the auscultation of crackles in Maurice Arviso s lungs Score Feedback lt span style font 10pt verdana color blue Textbook Max 10 reference p 596 lt span gt HTML Editor S 3 Points 10 This item will be graded later Earned Correct Crackles are typically heard during inspiration and cannot usually be cleared with coughing Answer As with Mr Arviso crackles occur most frequently in the bases of the lungs Mr Arviso s pneumonia is most likely contributing to the auscultated crackles
57. US NEXT gt Copyright 2011 by Elsevier Inc All rights reserved Na es 38 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS M u Iti m ed la Res ources PREPARATION v SCENARIO v DEBRIEFING v RESOURCES v Multimedia Resources 4 PREVIOUS Screen 19 of 19 The SLS is embedded with numerous multimedia resources that correlate to the scenario or to the S ze Topic Anatomy and Physiology 4 type of patient represented to further enhance understanding of the nursing concepts Anima tions skills videos and audio clips offer review of physiologic processes and nursing procedures Ei and are available to students for reference and review before or following simulation although r1 Resolution of Pneumonia r1 Animations and Video IV Antibiotic Therapy for Pneumonia Pneumonia access can be restricted at your discretion 4 PREVIOUS Electronic Medical Record The nurse s effective use of an EMR is directly related to improved patient outcomes in the health care set ting Nursing students must be able to access retrieve and interpret health related information effectively in order to provide safe optimal care to their patients When reviewing a patient s record nursing students must gather and interpret the pertinent data while sorting through the voluminous amount of information provided The SLS provides an opportunity for students to learn these skills through the use of a fully functional EMR for each simulation s
58. Zanotti MS RN CEN CCRN Clinical Nurse Specialist Emergency Department Ronald Reagan UCLA Medical Center Los Angeles California SKILLS DRILLS CONTRIBUTORS Deborah Bambini PhD WHNP BC CNE Associate Professor Kirkhof College of Nursing Grand Valley State University Grand Rapids Michigan Cathy A Catlett RN MSN Instructor University of Colorado Denver College of Nursing Aurora Colorado Emily Droste Bielak RN PhD Associate Professor Kirkhof College of Nursing Grand Valley State University Grand Rapids Michigan Alice Elaine McKeown MSN RN Nursing Faculty Washtenaw Community College Ann Arbor Michigan Annette K Orangio MSN RN Simulation Specialist Pensacola Junior College Pensacola Florida Elizabeth A Read MS FNP BC Adjunct Faculty Grand Valley State University Grand Rapids Michigan LEARNING RESOURCES CONTRIBUTORS Tracy Blanc RN BSN Instructor School of Nursing Ivy Tech Community College Terre Haute Indiana Kim Cooper MSN RN Department Chair Practical Nursing amp ASN Assistant Professor School of Nursing Ivy Tech Community College Terre Haute Indiana Kelly J Gosnell MSN RN Associate Professor School of Nursing Ivy Tech Community College Terre Haute Indiana Melyssa Jane McCoy RN BSN Faculty School of Nursing IVY Tech Community College Terre Haute Indiana REVIEWERS Deborah Bambini PhD WHNP BC CNE Associate Professor Kirkhof College of
59. aged to participate n the I am wondering why Would you describe more about this discussion Observers should be encouraged to Phase 4 Integration provide feedb ack usin g the Observer Evaluation During the integration phase the facilitator assists the students to apply theoretical content to the simulation as well as to anticipate the transfer of knowledge to the clinical Rubric Linking Theory to Practice Durin g th e R esp onsiv e In quiry ph ase th e fa cili e Use the debriefing questions designed for the specific scenario tator has several options for stimulating critical Assimilation thinking and modeling clinical decision making How will this experience influence your patient care for students The Performance Checklist could P w you new do differently to prepare for clinical be reviewed including both positive feedback Phase 5 Closere With 1 2 minutes left ask for any final thoughts on the scenario or the simulation and honest evaluation of events that occurred dur experience End with positive comments such as ing the scenario If your simulation center has the really appreciate how you capacity for recording the scenario the recording It seems like this was a really good learning experience can be reviewed with students at this time allow Ire appreciate everyone s participation 1n g the f acilitator to p ause and ask critic al think Developed by Deborah Bambini PhD RN WHNP C
60. ansition and outcomes boxes on the Algorithm Quick Card Name the files accordingly and save them in a preprogrammed folder for use during the scenario Performance Checklist FA Performance Checklist Evaluation Rating Performance Criteria Comments Does Not Designed for the facilitator the Performance Checklist details the expected student perfor mance objectives specific to the scenario The Performance Checklist is used for summative student evaluation following the simulation scenario As the student progresses through the scenario the facilitator can easily place a checkmark in the appropriate column Exceeds Expectations Meets Expectations or Does Not Meet Expectations and make comments Performs hand hygiene Before and after patient contact After removing gloves Uses gloves When in contact with bodily fluid Between dirty and clean tasks Verifies patient identity with two identifiers Facilitates informed patient consent for care by explaining actions to be Copyright O 2011 by Elsevier Inc All rights reserved 28 915 IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS The Performance Checklist is provided in the Facilitator s Packet and can be referenced in list format from anywhere within the Implementation Module by clicking on the icon 241 on the scenario header bar to the right of the scenario title The Performance Checklist should be shared with students d
61. ario Fundamentals 1 Fundamentals 2 Fundamentals 3 Patient Data Scenario Time Debriefing Time Alice Morrison 7 years Female Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Bernadette Jackson 85 years Female Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Samuel Green 75 years Male Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Scenario Concepts Concepts e Assessment Pediatric patient Nutrition Skin integrity and wound care Medication administration G tube Documentation and informatics Concepts e Vital signs Assessment Older adult Urinary elimination Medication administration IV Patient safety Patient education Documentation and informatics Concepts Assessment Older adult End of life care Older adult Communication Culture and ethnicity Documentation and informatics Scenario Skills Assess patient Recognize elevated temperature Recognize disconnected G tube feeding saturated dressing and wet bed pad Utilize age appropriate communication Respect mother s role as primary caregiver Change G tube dressing and provide hygiene Delegate tasks appropriately Administer antipyretic via G tube Restart G tube feeding Access and document care in the EMR Assess patient and lab results Recognize confusion tachycardia discomfort minimal urine output and positive urinalysis as abnormal find
62. ath feel so weak deep breath The Algorithm Quick Card is a one page visual depiction of the three phases of the scenario designed as an easy reference for the simulation facilitator The Algorithm Quick Card summarizes the patient progression the student s expected actions and the main possible scenario outcomes in a succinct graphic representation The facilitator should keep the card readily available as the scenario progresses and use it as a guide for transitioning the scenario from one phase to the next Age 60 DOB February 22 bed and floor deep brea ith feel NKA badly for making this mess deep breath my oxygen came off deep breath as reached for the urinal Phase Il expected student performance deep breath 1 Prioritizes respiratory interventions over personal hygiene interventions 2 Raises head of bed and patien 3 Administers oxygen via nasal cannula to oxygen saturation level above 92 4 Explains need to decrease oxygen demands e g minimal talking rest 5 Changes bed linen and cleans patient 6 Maintains dignity and privacy 7 Cleans urine spill on floor is administered and head of SR 101 6F 38 7 C BP 126 70 K 98 RR 24 Sat 89 2 L min via nasal cannula t states I feel a little better deep breath but 1 stil can t catch my breath e Sat 91 E L min via nasal cannula If oxygen is NOT administered t states I feel a little
63. c Primary diagnosis Pnuemococcal pneumonia Pregnant female patient at 16 weeks gestation is admitted with hyperemesis and dehydration Primary diagnosis Hyperemesis gravidarum Secondary diagnosis Dehydration Patient with a history of osteoarthritis is admitted to the orthopaedic unit following a right total hip replacement Primary diagnosis Osteoarthritis Secondary diagnosis Total hip replacement Copyright O 2011 by Elsevier Inc All rights reserved Na 13 Primary Challenge Learner assesses prioritizes and implements nursing care for a patient experiencing dyspnea and loss of independence Learner assesses and implements nursing interventions for a pregnant patient experiencing persistent vomiting dehydration and fluid and electrolyte imbalance Learner assesses and implements nursing interventions for a postoperative patient with pain mild post operative atelectasis and impaired physical mobility 14 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Scenario Fundamentals 11 Fundamentals 12 Patient Data Scenario Time Debriefing Time Kyle Miller 41 years Male Scenario Time 15 20 minutes Debriefing Time 15 20 minutes Lillian Chambers 40 years Female Scenario Time 20 25 minutes Debriefing Time 20 25 minutes Scenario Concepts Concept
64. care for the patient and concludes with debriefing and post simulation activities designed to promote reflection and deeper understanding The pre and post simulation exercises quizzes and multimedia resources are designed to enhance learning outcomes and assist the facilitator in student evaluation The SLS contains a wide array of resources As you learn about the vast opportunities of this product you will find that most of the work of running a simulation has been done for you Before heading to the simulation lab or selecting a scenario to run with your students take some time to familiarize yourself with the resources tools and guidelines of the SLS Descriptions of each of these resources can be found in this guide Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 3 The SLS Home Page All SLS program data can be accessed via the Evolve online course portal Evolve is the gateway to your textbook specific simulation product Simply select the SLS for your adopted textbook and you are on your way The SLS Home Page on Evolve contains links to all of the SLS materials Once you are on the Home Page for the SLS don t let the simplicity of the presentation fool you Behind each click is an extensive set of resources for running successful simulations e The Implementation Guide is this m BESSER SI
65. cenario The EMR allows students to reference important patient data and docu ment assessment findings and care given during simulation using forms and methods similar to those they will use in both the clinical setting and in practice The EMR should be accessible in or near the patient s room during simulation To launch the EMR the student logs into their own Evolve account Any modifications made to the EMR under a student s login will be saved only to that student s account Student EMR documentation during the scenario can be saved and retrieved later by the student for further charting and electronic submission to the instructor or documentation can be submitted immediately after the scenario for evaluation Students should reference the EMR User Guide in their SLS Evolve account for specific instructions about how to use the EMR how to submit documentation to their instructor and how to access EMR support if needed Although particular aspects of the EMR may or may not be relevant to the scenario all sections of a basic patient chart are included for each scenario to closely mirror a real patient chart The facilitator can use any parts of the EMR to reinforce other pertinent clinical concepts in debriefing or individually with students as time allows As in the real clinical setting portions of the EMR may have data omissions giving the student the opportunity to discover the missing data and interpret the consequences of the omissions Each
66. cepts Assessment Stress and coping Sexuality Bowel elimination Skin integrity and wound care Patient education Documentation and informatics Concepts e Vital signs Assessment Communication Older adult Patient safety Skin integrity Patient education Documentation and informatics Concepts Vital signs Assessment Infection control Oxygenation Skin integrity and wound care Communication Patient education Documentation and informatics Concepts Assessment Skin and wound care Diabetes management Medication administration SQ Patient education Documentation and informatics Scenario Skills Assess patient Recognize leaking colostomy bag Recognize knowledge deficit regarding colostomy care Recognize ineffective coping disturbed body image and low sexual self esteem Utilize therapeutic communication Ensure patient privacy Assist patient with colostomy care and hygiene Provide patient education and support Access and document care in the EMR Assess patient Utilize therapeutic communication Assess fall risk using Morse Fall Scale Asses pressure ulcer risk using Braden Scale Implement fall prevention measures Implement pressure ulcer prevention measures Provide patient education and support Access and document care in the EMR Assess patient Recognize moderate respiratory distress Conduct sterile tracheostomy suctioning and dressing care Maintain contact isolation p
67. cumentation and informatics Scenario Skills Assess patient Recognize dyspnea Recognize patient s frustration related to loss of independence Prioritize respiratory interventions Administer oxygen therapy Utilize therapeutic communication Maintain privacy and promote dignity Assist with personal hygiene Provide patient education and support Access and document care in the EMR Assess patient and lab results Recognize nausea and vomiting Administer IV antiemetic per PRN order Recognize abnormal lab values including low serum potassium Change IV fluids per standing order Monitor intake and output Provide patient education and support Access and document care in the EMR Conduct postoperative assessment Assess and recognize pain Recognize bibasilar crackles in lungs Recognize elevated temperature Recognize impaired mobility Administer IV pain medication per order Administer SQ anticoagulant per order Assist patient with postoperative exercises Provide patient education and support Access and document care in the EMR SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Simulation Presentation Patient Diagnoses Patient is admitted with community acquired pneumonia Patient struggles to maintain independence in daily cares and refuses assistance despite dyspnea upon exertion Just before scenario begins patient spills urinal and nasal cannula falls out of reach Patient becomes dyspnei
68. d and students will not be able to modify the existing H Save Download Submit Restart UI Log off GIMULATION LEARNING SYSTEM E E MEN 7736811 Room 233 Age 60 Provider Patrick Cronin MD Code Status Patient Maurice Arviso Gender Male Weight 155 Ib Allergies Full code identification FEE a Nursing Admission Adult Profile Health Promotion Nutrition Metabolic Elimination Activity Rest Perception and Cognition Self Perception Role Relationships Sexuality Coping and Stress Tolerance Life Principles Safety Protection Comfort Pain Growth and Development ADULT PROFILE e How to be addressed s Flow Sheets A Medication Records Nurses Notes 1 Orders Maurice Physician s Progress Notes oe SS Admission date Thursday i Laboratory Reports Reason for this admission as stated by patient chief complaint I can t stop coughing and I m having trouble catching my breath I m Diagnostic Reports coughing up red stuff Consults Procedures R F Diagnosis Pneumococcal pneumonia a History and Physical Allergies and reactions i Nursing Admission Drugs No known drug allergies i Surgical Reports Food No known food allergies A Emergency Department Other Patient Education Armband name verified Yes D Demographics R E Patient instructed in the use Call light Bed rails i Consents of Signatures Smoking policies Visiting hours Date of birth F
69. d to be cut out and used during the simulation Facilitators may find it useful to laminate the bands and store them with scenario specific documents and materials for future use S lt Identification Wristbands E Arviso Maurice b MR 7736871 b e DOB February 22 Y pS Age 60 A S Risk Alert Wristbands p n m High Fall Risk ON Risk Alert Color Codes Allergy E Fall Risk 6 DNR Restricted Limb Latex Allergy Patient Band Name Medical record number 7 Of birth Risk Alert Allergy m Band indicates that patient has allergy identified Risk Alert Fall Risk Band indicates that paitient has determined fall risk Risk Alert DNR Band indicates that paitient has a do not resuscitate order Risk Alert Restricted Limb Band indicates that limb to vvhich band is placed has restricted access Risk Alert Latex Allergy Green 0 Band indicates that patient has a latex allergy Copyright O 2011 by Elsevier Inc All rights reserved A E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS RN to RN Patient Report Clear communication of patient information dur ing hand off or at the change of shift is essential to error prevention in the clinical setting The RN to RN Patient Report offers detailed infor mation in SBAR format regarding the patient s situation background and assessment findings as well as recommendations for care The RN to RN Patient Report may be accessed fr
70. d with corresponding textbook refer ences The facilitator can refer students to these textbook references for remediation and guidance if needed Guided Discussion Growth and Development Students are encouraged to consider how the patient s condition may impact social interactions family dynamics and role performance In this section growth and development considerations including Erikson s stages specific to each patient are presented with corresponding textbook refer ences Guided Discussion Culture and Diversity Culture and diversity considerations are presented for each scenario with textbook references PREPARATION SCENARIO Y DEBRIEFING Y RESOURCES v Guided Discussion Patient Teaching 4 PREVIOUS Screen 15 of 19 NEXT 1 Teaching the aging adult Key Points e Make sure the patient is ready to learn Sit facing the patient and speak slowly e Give the patient enough time to respond especially in the Native American culture words are chosen car Do not stereotype the older adult Speak with a lower tone of voice Ask for feedback to make sure that the patient understands the information Emphasize and integrate emotional and personal values in the acquisition of skills and ideas Text Reference p 193 Incentive spirometer Key Points Purpose of the incentive spirometer e Promotes deep breathing Prevents atelectasis Use of the incentive spirometer e Inhale slowly maintaining con
71. displayed in the scenario header of the Implementation Module These icons offer easy access to frequently used resources A The Facilitator s Packet PE is a convenient printable PDF that includes resources needed for preparation and implementation of the scenario The resources in the Facilitator s Packet are located in various places within the Implementation Module and compiled here for easy reference A link to the Facilitator s Packet is also found under the Preparing Yourself screen of the Preparation tab B The Electronic Medical Record EMR isa fully interactive medical record that the learner will use to reference and document patient data before during and after the scenario This quick access icon is the main faculty access point for the EMR C The RN to RN Patient Report s summarizes the patient s condition immediately before the scenario begins This report is used to initiate the simulation experience A link to the RN to RN Patient Report is also found on the Jnitiating the Simulation Experience screen of the Scenario tab D The Algorithm Quick Card provides the facilitator with a visual progression of the scenario A link to the Algorithm Quick Card is also found on the Scenario Phase I Introduction screen of the Scenario tab E The Performance Checklist may be used for evaluation of student actions during the scenario A link to the Performance Checklist is also found on the Scenario Phase I Introduction sc
72. e Guide faculty Of staff member S 9 OT volunteer S may be very supportive of his father His mother died a year ago in the hospital and Jonathan is scared 2 2 2 that his father might also die Jonathan is awkward in the room and reluctant to participate in the care of his father as a result of as S1 gned the role of f amily member or friend of sted gt out of the room at his father s request in order to let his father use the p atient The p erson p laying this role should Jonathan is anxious because his father is not breathing well eye assessment Does he need help be given adequate time to review the Additional Dad are you OK EE He looks like he s having a hard time breathing Participant Response Guide and prepare to use D nn MEME a e a Why does he get short of breath ve never seen him like that before comments during the scenario Playing the role of nipale nea Should bring in Dad s herbs from home The shaman mixed up special herbs for Dad They will e o bed is NOT elevated He still looks pretty uncomfortable into the feelings of a visitor 1n a health care env1i ae Jonathan is worried because his father is not better p administen but Is he better now ronment The thoughts and emotions of the visitor emer Hesil seems to be having a hari time breathing should be discussed during the debriefing session and di
73. e method and duration of administration and contraindications It is the responsibility of the practitioner relying on their own experience and knowledge of the patient to make diagnoses to determine dosages and the best treatment for each individual patient and to take all appropriate safety precautions To the fullest extent of the law neither the Publisher nor the Authors assumes any liability for any injury and or damage to persons or property arising out or related to any use of the material contained in this book ISBN 978 1 4377 2641 1 Vice President and Publisher Tom Wilhelm Senior Editor Jeff Downing Developmental Editor Danny Witzofsky Associate Developmental Editor Kristen Prysmiki Editorial Assistant Chelsea Newton Marketing Manager Susan Copeland Book Production Manager Gayle May Book Production Project Manager Tracey Schriefer Product Developer Jim Twickler Associate eProject Manager Jared Gilbert Web Design Manager Jessica Birkhead Working together to grow libraries in developing countries Printed in the United States of America www elsevier com www bookaid org www sabre org i ELSEVIER BOOKAID Sabre Foundation Last digit is the print number 9 8 7 6 5 4 3 2 SUBJECT MATTER COORDINATOR Fara Bowler MS APRN ANP C Coordinator Clinical Development Programs Senior Instructor College of Nursing University of Colorado Denver Colorado CONSULTANTS Anne Griffin Perry RN EdD FA
74. eb 22 Gender Male Female T F 102 4 F 39 2 C Blood pressure 130 72 systolic diastolic 5R E x JM y Prid Dr dee nr i data Subsections of this comprehensive nursing form include the following Patient Profile Health Promotion Nutrition Metabolic Elimination Activity Rest Perception and Cognition Self Perception Role Relationships Sexuality Coping and Stress Tolerance Life Principles Safety Protection Comfort Pain and Growth and Development These categories provide data necessary for students to provide holistic care to the simulated patient Students can use this information to create pertinent nursing diagnoses and a comprehensive plan of care for their patients Copyright O 2011 by Elsevier Inc All rights reserved Na 44 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS SURGICAL REPORTS Surgical Reports are included in the EMR if the simulated patient underwent a surgical procedure Reports include the following Anesthesia Questionnaire Operative Report PACU Discharge Preoperative Checklist Preoperative Patient Instruction and Surgery Unit Admission Form This portion of the EMR cannot be modi fied by the student The facilitator can use this information to reinforce operative content such as the preoperative assessment consent for treat ment preoperative checklist and important legal implications r
75. een 08 of 19 NEXT gt Start the scenario Progress the patient situation following the AE Algorithm Quick Card Evaluate the student using the AE Performance Checklist Physiologic State T 101 6 F 38 7 C Heart sounds Regular E 2 72 Lung sounds Crackles bilaterally RR 28 Abdominal sounds Present Pulses 2 Normal Maurice states I used the urinal deep breath tried to hang it on bedrail deep breath spilled it on bed and floor deep breath I feel badly for making this mess deep breath my oxygen came off deep breath as I reached for the urinal deep breath O Sat 88 room air Situation Transition Maurice Arviso is lying crooked in bed with the head of bed flat His sheets are disheveled and urine is spilled on the bed and floor The nasal cannula is out of reach Maurice is dyspneic and can only communicate in four to five word phrases He is frustrated and embarrassed Recommended time to advance to Phase II 5 minutes Expected Student Performance 1 Conducts initial and focused assessments 2 Recognizes abnormal findings Shortness of breath e Anxiety and frustration Tachypnea Decreased oxygen saturation level e Elevated temperature e Crackles in lung fields 3 Notes urine spilled on floor and bed 4 Utilizes therapeutic communication to address patient concerns 4 PREVIOUS NEXT gt that should be programmed into the simulator The Situation Transition
76. elated to operative consents EMERGENCY DEPARTMENT Data will be found in the Emergency Depart ment record if the simulated patient experienced an emergency department ED visit during the current admission This multidisciplinary docu mentation form contains the following subsec tions Patient Demographics Chief Complaint Initial Assessment Systems Review Medication Record Laboratory Record Radiology Record Nurse s Notes and Provider s Progress Notes If the simulation scenario takes place in the emer gency department the student will be able to enter data in this form to reflect care adminis tered The facilitator can discuss how this ED Bs Intraoperative Record Name Lillian Chambers Age 40 Sex Female Physician Rhonda Spratt MD MRN 7781324 Room 437 Friday Time 0900 Medical Stretcher To OR From Surgical Unit Transfer By Gretchen Lucas Patient Identification Time Out and Double identifiers RN Initials GS Allergies and Reactions NKA Mental Emotional Status Alert and oriented Anxious but cooperative and calm Preoperative AntibioticDocumented Piperacillin tazobactam 4 5 g IV at 0800 KL Intraoperative Record Page 1 H Save 2 Download E Submit Restart Log off GIMULATION LEARNING SYSTEM MRN 7753214 Room 211 Age 85 Provider Kenneth Young NP Code Status Patient Bernadette Jackson Gender Female Weight 1211b Allergies i ONR gt Identification 8 Eme
77. en though he experiences shortness of breath with any exertion Just before the scenario begins Maurice attempts to use intervene and evaluate the effect of the nursing the urinal independently and spills urine on the bed and floor In the process he accidentally pulls off his nasal cannula which falls out of 1nterventions his reach He is frustrated and embarrassed and soon becomes dyspneic without his oxygen The scenario takes place on Thursday at 1600 During this scenario students will have the opportunity to assess plan prioritize and implement nursing care for a patient experiencing dyspnea and loss of Overview The scenario overview offers a brief 25 sketch of the patient and the events occurring 0010000000 before the scenario start time A description of M the patient upon initial contact is also provided along with the nursing actions to be performed Recommended Scenario and Debriefing Time Limit Recommended scenario and debriefing time limits are identified on the first screen with suggested times based on the number of performance objectives for each simulation scenario and the scenario phases The facilitator must remain flexible however because student performance during the simulation scenario is not always predictable The struggling student may take longer to achieve the performance objectives of a given simulation scenario whereas the more experi enced or confident student may progress mo
78. ence If for instance a stat ultrasound is requested during the course of the simulation scenario the facilitator should report the results verbally via telephone to the primary nurse or present the primary nurse with a printed or projected ultrasound results report The facili tator may wish to use the contents of the Diagnostic Reports section as a tool to review with students the nursing care of the patient before and after a procedure The Diagnostic Reports also allow the facilitator the opportunity to discuss actual test results related to the patient s diagnosis and explore implications for patient care with the students ion Right upper lobe infiltrates Radiology Report Page 1 Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS CONSULTS PROCEDURES If the simulated patient was assessed by a spe cialist such as a cardiologist nutritionist or social worker a report of the visit is located in the Consults Procedures tab This section can not be modified by the student The facilitator may use this information to discuss with stu dents the potential patient implications and nursing interventions related to the specific consult HisTORY AND PHYSICAL The History and Physical tab contains the initial history and physical H amp P report Subsections of this comprehensive form include the f
79. ent can submit the answers to the facilitator These pre simulation exercises should be discussed during the debriefing session following the simulation The Pre simulation Quiz contains 6 to 10 multiple choice questions that allow students to evaluate their knowledge and understanding of the reading assignment prior to simulation Once students submit their answers the quiz is automatically graded and rationales are provided for the correct and incorrect answers along with textbook page references The quiz grades can be automatically entered into the instructor s gradebook Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 47 POST SIMULATION LEARNING RESOURCES _JPost simulation Learning Resources Following the debriefing session the facilitator may wish to assign post simulation activities Scenario 8 Journaling These activities are designed to summarize the ere on your simulation experience important elements of each scenario reinforce had s Calal relevant concepts promote student self reflection Using the SBAR method provide a change of shift report for the oncoming nurse and encourage retention and understanding of the nursing care related to the scenario Post simula tion assignments be performed independently A scenario 8 Post simulation Quiz or in a group setting led by a facilitato
80. ep Jo juaned ay aziubogay 9Je2 2 S l u dulo2 NASH b l d onnadelay solueu G Ajiue4 uoneoiunuJulo onnedeJou 9J o pu3 sulejs S uoddng NSISAIQ III jueuieDeue N SS HS SISUD suoneJejy 0 suwsilueysay buido UHE H uo seouenju jenyidgs pue snolbiioy s rou pu d q JOUIO pue 0 sjdeouo2 uyeeH 9 SSO pue J99 B9N SSNQY 0 pejuui jou s q S pnioul juejuoo pajejay SS UIII 214 JO ejnoe yM sjuened se se sjue e njsseJis Buroueuedxe sJeuyo jueoyiuBis Aplue pue juened ay jo Bulaq jam eroos pue jejuau JeuonouJe ay suoddns pue sejowoJd yey eeo Sulsinu step pue sinu 8u 4 1 H931NI TVI2OSOH2ASd AMOS31VO eX319N ALIMDALNI IVIDOSOHIASd E p3uoo ouqns uoneniEAzI Copyright O 2011 by Elsevier Inc All rights reserved 61 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS SJQO N 55 pojeioosse 2 Ul E U 1U A LG pL eOH baje1 s ejes juaned e se ales umo Jiey ui AJOL sjuened abeno9uy CL Log SEL uo Bunjnses uueu juened JO su v SINPIY 6 00 s e09 Ajayes 3uaneg jJeuoneN 010Z P el M a120 yyesy euundo jo
81. es Notes Day dh Orders hh AZ d mm Y Physician s Progress Notes a Laboratory Reports Linked Forms Diagnostic Reports Thu 1545 Patient is resting comfortably No complaints voiced Braeden Dobbins RN Consults Procedures c a Thu 1530 Physician called with complete blood cell count results Braeden Dobbins RN a History and Physical Telephone order received for 1 g cefotetan IV every 12 hours and azithromycin 500 mg by mouth daily First doses Nursing Admission of each medication ordered now Order rea confirmed First doses administered per order IV without j Surgical Reports redness or swelling antibiotic infusing without difficulty Radiology tech at bedside Chest x ray completed a Emergency Department Patient Education Thu 1450 Peripheral IV started in right hand Flushed with 3 mL of Braeden Dobbins RN normal saline IV dextrose 596 in lactated Ringer s at 75 Demographics mL hr started Sputum for culture obtained and sent Blood a for lab drawn and sent Patient awake Son is at bedside and gConsents supportive Son asks whether it would be all right if their shaman came to the hospital to provide spiritual support to Signatures his father Patient and son assured that this is OK Thu 1430 Medication reconcilation form complete Assessment Braeden Dobbins RN completed as well and documented in EMR Lungs auscultated crackles noted in lower lobes Sputum is rust colored Patient and son educated regarding
82. estrict access by individual student 8 RN to RN Patient Report Settings Normal Advanced Assignment Access Tracking I ser Tracking Disabled v Conterk itandards Automate View Restrictions Ll Do not allow users to view this item User Access Role Team Access v Viewable By Students M Team Access All Teams 4 Under View Restrictions select Individual User Access from the User Access drop down menu If you wish to restrict access by using teams leave this selection as Role Team Access RN to RN Patient Report Settings Normal Advanced Access Tracking E Tracking Disabled v View Restrictions L Do not allow users to visas Individual User Access Team Access Al Teams e ai Copyright O 2011 by Elsevier Inc All rights reserved AE es 50 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 5 A list of currently enrolled students will appear in the User Access List Check the box next to each student s name to make that resource available Un check the box to deny access 8 RN to RN Patient Report Settings Normal Advanced Content Access Standards Automate Assignment m Tracking Do not allow users to view this iter Individual User Access User
83. facilitator notes that students are struggling and the sce nario progression is compromised the facilitator may wish to prompt students using verbal clues from the patient For example if students have not identified postoperative bleeding after a basic assessment the patient may hint at the problem by saying Oh I am so light headed and I feel like my bed is all wet Can you check to see if I wet the bed In many cases these clues will be enough to redirect the scenario If students remain at a total impasse an alternative 1s to call a time out in which the facilitator pauses the scenario and talks with students about their perception of the situation and their plan of care Following the time out the facilitator may choose to begin the scenario from the beginning or continue with the scenario from the pause point The Algorithm Quick Card can be used as a guide to run a simulation scenario with or without using pre programmed files Any scenario can be run entirely on the fly without preprogrammed files using the Algorithm Quick Card as a reference or scenarios may be run using preprogrammed files or frames corresponding to the initial settings transition and various possible outcomes You can choose the method that works best for you To create preprogrammed files for use in your simulation center open the file pro gramming feature in your particular simulator software and enter the data provided in the initial settings tr
84. fujauepiooV 0 Dau jou 51 nq sepnjour u uo pajejay SpJezeu ejueujuoJiAue pue yeay woy euuosJed eJeo Ulle v pue sjeujo jueoyiuDis AjiuueJ sjuened Bunoejoud 10 LNOO NOLLO34N ANY ALSAVS AMOO31VOSRS eX319N JeuuosJed yyesy pue sJeujo jueonubis A mue sjuened 398 0 d o Japo ui Dunes lenijep Sued ay seoueuue ey Buisinu pue Aq s wo9 no juened o juawanalyoe ay sejououd sinu Sy LNSIAINOHIANS SHVO 31193443 ANY S4VS AHOO31VO eX319N 1OM1NOO NOLLO3HNI ON AL34VS 1N3IINOMNIAN3 34V 3ALLO3443 ANY JAWS Z pjuoo onuqns uonen e 3 19A19SQO Copyright O 2011 by Elsevier Inc All rights reserved 99 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS baje s Ajayes juoened e se ag umo 11y ui jueuleA oAur sjuened eDejnoou3 CL Log Synpe Japjo pezijeuonnjnsut ui eseesip jeoogounaud pue ezuenjul JO ySII v SDNP9Y 0 20D 61200 Jajes 3uaneg jeuoneN 010Z OI yyesy euundo jo Alain JOJ SAN eA pue 5 jiuej juened pue esiiedxa jeu uy eouepi oe 4 1999 a e103 U peseg o2uopil 3 Speeu pue senj eA saguaJajald 5 104 0 458 uo paseq pejeurpjyooo pue ejeuoisseduuoo ul Jeujied pue jo e2Jnos y se eeuBisep Jo juaned ay aziuboday 9Je2 paJojue juaHed S l u dulo2 NASH pe ejoy uyeoH juau
85. herapy Temperature Regulating IV Flow Rate Pulses IV Maintenance Respirations IV Dressing Change Oxygen Saturation Pain Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 7 Oxygenation Suctioning Artificial Airway Chest Tubes Oxygen Administration Nutrition Small Bore NG Insertion Tube Feedings Intake and Output Elimination Nasogastric Tube Gastrointestinal Aspiration for pH Measurement Condom Catheter Indwelling Catheter Care Straight or Indwelling Catheter Insertion Indwelling Urinary Catheter Removal Closed Catheter Irrigation Urine Specimen Collection Enema Ostomy Pouching SKILLS DRILLS STUDENT VIEW For each drill students have access to a Student Challenge an Electronic Medical Record EMR and a Video Demonstration The Student Challenge includes a brief summary of the patient situation a reading assignment and a specific skill related challenge Each drill revolves around a simulated patient and the patient s EMR The current day and time info serves as a grounding point and corresponds to the EMR data A specific patient situation or order drives each challenge Drainage Pouch Emptying Bedpan Urinal Placement Blood Test Occult Mobility Immobility Transfer Techniques Moving and Positioning Restraints Fall Risk Assessment Skin and Wound Care Pressu
86. ia nasal cannula maintain oxygen saturation greater than 9296 13 Incentive spirometer 10 times per hour while awake d 14 TV access Perinheral TV ELSEVIER A Elsevier All rights reserved wv gt E Save 2 Download E Submit Restart Log off GIMULATION LEARNING SYSTEM MEN Patient 7736871 Maurice Arviso Room 233 Gender Male Age 60 Weight 155 Ib Provider Patrick Cronin MD Code Status Allergies Full code dentificati e Physician s Progress Notes Fi Flovv Sheets R Medication Records DAY TIME PROVIDER S PROGRESS NOTES PROVIDER S SIGNATURE g Nurses Notes Thu 1430 Maurice Arviso a 60 year old male has been a patient of mine for many years He presented today to my office with a chief complaint of fever chills and a bad cough His temperature was 103 2 F 39 6 C On exam crackles were noted in right lobes Cough produces rust colored sputum Respiratory rate increased into the 30s and shallow He is complaining of chest pain with cough Most likely community accquired pneumococcal pneumonia Because of his high fever presentation and asplenic status I recommend hospitalization Blood pressure stable in office Admit to medical floor for IV antibiotics and observation Patrick Cronin MD Orders Physician s Progress Notes i Laboratory Reports Diagnostic Reports Consults Procedures il History and Physical A Nursing Admission i Surgical Reports Emerge
87. ient s feet as if it had been dropped Fill emesis basin with small amount of simulated sputum and place on bedside table optional Place used tissues moistened with simulated sputum on bedside table and floor optional Place trash bin and linen bin or bag in patient room Stock supply cart with clean linens and bed pad disinfectant wipes and standard equipment see implementation guide Stock medication cart with medications listed At start of the scenario position son outside patient s room Instruct son to enter room at the same time as the student NOTE Isolation precautions for community acquired pneumonia vary by state and institution Standard precautions are assumed in this scenario It is recommended that the facilitator refer to local guidelines and stock appropriate personal protective equipment in a cart immediately outside the patient s room if needed In addition to scenario specific props the simulation area should be stocked with standard props These standard props include items commonly found in a patient care setting Since standard props are not usually listed on the scenario specific Staging Instructions take time to be sure that all standard props are in place when staging each scenario It may be helpful to print a copy of the standard props list included here to use as a checklist for each scenario Copyright O 2011 by Elsevier Inc All rights reserved SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTA
88. ing gt Simulation Scenarios Daniel Witzolsky rare L Post simulation Learning Resources Add Content Rearrange Settings Reports Utilities Delete Publish Print Scenario 8 Journaling d Reflect on your simulation experience Scenario 8 Interdisciplinary Communication Using the SBAR method provide a change of shift report for the oncoming nurse F Scenario 8 Post simulation Exercises settings reports delete Scenario 8 Post simulation Quiz 3 Select View Grade or Delete Submissions from the list of utilities Y Scenario 8 Post simulation Exercises Utilities Menu View Grade or Delete Submissions Review and grade submissions to this quiz Grade by Question Grade ungraded responses by question Export Submission and Grade Data Export submission data to a text file Pending Items View and delete pending items Associated File Manager Upload and manage files associated with this item Move Item Move this item to another folder Export Item Export this itern to another section Email Quiz Send this quiz to any Internet email account Add to Pool Adds all questions to the question pool with a specified keyword Calculated Question Creates a series of questions based on a specified formula Convert Quiz to Assessment Create a copy of your quiz in the current folder and convert it to an assessment Copyright O 2011 by Elsevier Inc All rights reserved SLS IMPLEMENTATION GUIDE FOR NURSING F
89. ings Report abnormal findings to provider using SBAR Obtain sterile urine sample for culture Administer IV antibiotics Recognize increased fall risk Implement fall risk prevention measures Provide patient education and support Access and document care in the EMR Assess patient Recognize cessation of cardiovascular and respiratory function Notify provider of patient s death using SBAR Follow postmortem care policy and procedure Utilize therapeutic communication with the family Elicit the patient and family s preferences related to death rituals and postmortem care Respect the patient and family s spiritual beliefs and cultural values throughout the dying process Access and document care in the EMR Simulation Presentation Patient Diagnoses Pediatric patient with g tube is admitted with acute bronchitis Patient s G tube feeding becomes disconnected just prior to start of scenario Primary diagnosis Acute bronchitis Secondary diagnosis Esophageal atresia with gastrostomy Older adult with polyphar macy related dehydration and urinary retention is admitted for monitoring rehydration and IV antibi otics Patient experiences acute confusion related to a urinary tract infection Primary diagnosis Dehydration Secondary diagnosis Urinary retention Patient with inoperable pulmonary adenocarci noma and a documented code status of do not resuscitate DNR is admitted for palliative care
90. ize the assignments and gradebook to suit your needs Detailed instructions for configuring your gradebook are included in the Manage tab of the Evolve Learning System User s Manual which is also contained within the Tools menu Gradebook Setup 5tep 1 TIF Click Here to learn more about the gradebook setup wizard and other commonly used features Gradebook Mode Points This option enables simple points based grading Formulas are available at the assignment level only J Percentage This aptian enables percentage based grading Category weighting and farmulas are avallable Calculation a NN EN C tal Skip Wizard Nest Copyright O 2011 by Elsevier Inc All rights reserved Na 52 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS GRADING ASSIGNMENTS The SLS pre and post simulation quizzes are graded automatically by the Evolve Learning Management System All remaining assignments e g exercises essay questions concept mapping EMR documenta tion must be manually evaluated and graded by you 1 View the activity you wish to grade within the Simulation Scenarios directory 2 Select Utilities from the menu beneath the title of the activity Learning System Course Home LL riz ci Manage HET LOR gt Course Documents gt Simulation Learn
91. ke time to promote an environment that fosters constructive criticism and mature respect ful behavior To establish an environment conducive to learning make it clear that students must be respect ful to their peers during and after the simulation experience and that there should be no ridiculing or demeaning of a peer who may have made an error Students should understand that a debriefing session will be conducted following the scenario in which all participants will be given the opportunity to critically reflect on both the strengths and weaknesses of their performance as well as areas in which they can improve If written permission to film student performance is required in your simulation lab permissions should be obtained during orientation Copyright O 2011 by Elsevier Inc All rights reserved Na 30 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Role Assignment Following orientation students should be assigned specific roles to be played during the simulation scenario The facilitator may choose to assign student roles or allow students to randomly choose badges to determine their role Each scenario includes the role of the primary nurse and secondary nurse with some scenarios including additional participants such as a nursing assistant or a patient s family member or friend In general it is recommended that the role of the hea
92. lan of care e Providing individualized patient teaching 2 Function competently as a member of the health care team by Independently initiating care within nursing scope of practice Appropriately delegating tasks 3 Implement best clinical practices by Recognizing abnormal findings Shortness of breath Anxiety and frustration Tachypnea Decreased oxygen saturation level Elevated temperature Crackles in lung fields e Prioritizing and implementing appropriate interventions Administering oxygen therapy s Elevating head of bed Assisting with personal hygiene 4 Promote safety for patient self and others by PREPARATION SCENARIO v DEBRIEFING v RESOURCES v Patient Data 4 PREVIOUS Screen 03 of 19 NEXT ng Location Medical unit Patient name Maurice Arviso Medical record 7736871 Date of birth February 22 Age 60 Sex Male Admitting physician Patrick Cronin MD Scenario start day Day 1 Thursday Scenario start time 1600 Chief complaint upon admission Shortness of breath fever couging up rust colored sputum Primary diagnosis Pneumococcal pneumonia Secondary diagnosis None 4 PREVIOUS NEXT gt DEBRIEFING v RESOURCES v 4 PREVIOUS Screen 04 of 19 NEXT This module provides a framework for successful implementation of Scenario 8 with step by step instructions from preparation to debriefing and follow up Facilitator Action e Download and print the Facilitator s Packet
93. le the location characteristics and relieving factors Students should use the appropriate pain scale to evaluate the patient s pain and to determine trends related to pain management In addition stu dents can enter their own assessment findings in this section Intake amp Output This interactive page represents the patient s fluid intake and output since admission Depending on the course of the simulation scenario the student can enter the specific fluid intake either by IV or by mouth and output such as urine blood emesis nasogastric tube secretion or liquid stool obtained while caring for the simulated patient Additional learning activities using this record may include determining a trend related to intake and output values since the patient was admitted and using these data to determine the patient s fluid balance status Intravenous Therapy Information about intravenous therapy is recorded on this page The IV fluids and rates of administration can be documented by students Copyright O 2011 by Elsevier Inc All rights reserved Na 40 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Special Monitoring Information related to PCA Pump Monitoring can be found within this tab System Assessment This tab is organized according to biological and psychosocial systems Respiratory Cardiovascular Neurologic Gastrointestinal
94. ls Drills library found on the SLS Home Page These recommendations consist of the variations that most closely relate to the specific variation of each skill found in the scenario While instructors may at times find it useful to limit the Skills Drills assigned with a scenario to the list provided assigning several of the additional skill variations included in the library may be desired for the development of skill discemment and mastery 4 m T A e Wi 8 EA m OF ira yu AM Ur Category mm s o o oe Vam mairsa 0 Vital Signs Vital Signs COPD Poor Pen Vital Signs Oxygen Administration 1 Nasal Cannula Satura Incorrect Places in Act with Nasal Cana Abnormal in Fall Risk Assessment Confused IV Indwelling Catheter Fall Risk Assessment Environmental Hazard Water Spall Fall Risk Assessment 3 Unlocked Bed Side Rails Down EE VsiS s 0 Vaiss Vega Toys Visos Open Saraton Ongeraton Diener Use the Scenario Index to review the scenario diagnoses primary challenge and skills to identify the scenario best suited to the level of your students and your teaching needs The Scenario Index may be accessed from the SLS Home Page The index provides the best overview descriptions of the scenarios Copyright 2011 by Elsevier Inc All rights reserved A s Scen
95. lsevier All rights reserved record differs from documentation used on the clinical unit and why these differences exist For example by accessing this form students will be able to see how the care of the patient in the emergency department is focused on quickly diagnosing and stabilizing the patient and then preparing for transfer to the appropri ate clinical area PATIENT EDUCATION Patient education is a priority of nursing care in the clinical setting The Patient Education tab includes patient goals and a form outlining a systematic process for documenting educational interventions and progress toward meeting the goals A concise method of coding is used to assist with the documentation on the form As students provide patient teaching the interven tions can be documented and modified in the Patient Education section As with all other sections where students enter documentation data the facilitator can review and offer con structive feedback to students regarding patient User Danny Witzofsky dwitzofsky Scenario 8 Sim Day Time Thur at 1600 HIE SIMULATION LEARNING SYSTEM is cc Faite aimi id MRN 7736871 Room 233 Age 60 Provider Patrick Cronin MD Code Status Patient Maurice Arviso Gender Male Weight 155 Ib Allergies Full code Identification E 2 E B Patient Education Key Codes for Patient Family Teaching Flow Sheets g Medication Records EDUCATIONAL G
96. lth care provider should be played by a facilitator or faculty member as it is beyond a nursing student s scope of practice As facilitator you can include additional participants at your discretion such as charge nurse unlicensed assistive personnel or lab technician The inclusion of any assistive personnel allows the primary and secondary nurses to prac tice delegating tasks while the delegate is given the opportunity to perform appropriate tasks and experi ence an ancillary role The inclusion of students in roles such as friends or family members allows them to experience a health care setting from their unique perspective Be sure to give participants in scripted roles the Additional Participant Response Guide for their role available in the Facilitator s Packet The primary nurse is expected to act as the team leader during the scenario with the secondary nurse assist ing as needed within the nursing scope of practice Participants in both nursing roles primary and sec ondary should be encouraged to talk and think out loud as they practice their clinical decision making skills while also being cognizant of their communication techniques To ensure that all roles are clearly identified during the scenario have each student participant wear a badge Printable Participant Role Badges are available in the Facilitator s Packet You may also wish to provide costumes including wigs hats clothing or other props for particular roles to
97. mendations from within the scenario documents From the scenario menu click on the Skills Drills link This will pull up a list of the Skills Drills recommendations for the scenario This list can also be accessed through several links within the Implementation Module Access the Skills Drills library from the SLS Home Page see page 3 to review the details of recommended drills While the recommendations provided for each scenario consist of the skill variations that most closely relate to the specific variation of each skill encountered 1n the scenario additional variations from the library can also be assigned as desired Students have access to the full Skills Drills library so no action within the Evolve learning management system is required when assigning drills Scenario Index IScenario 8 Maurice A Implementation Module Oxygenation and Hygiene Skills Drills T View the Skills Drills recommendations for this scenario Scenario 8 Documentation EMR E J E Scenario 8 Concept Mapping Care Plan Constructor Pre simulation Learning Resources Lal Post simulation Learning Resources RN to RN Patient Report Algorithm Quick Card Observer Evaluation Rubric Multimedia Resources Scenario 8 Skills Drills Recommendations ARI SUO Z The following SLS Skills Drills are recommended for students in preparation of Scenario 8 They can be accessed through the Skil
98. n addi e Assign pre simulation homework to the student s rs e group tion to the scenario specific assignments the o You might say Prior to your scheduled simulation period on Thursday at EMR User Guide should be assigned as reading uu xu eripe with the patient s history A change of shift report will be provided to you before the first simulation scenario event and at the start of the simulation period should be continue to be accessible by students as a reference document throughout their simulation PREVIOUS NEXT training To activate assignments return to the main scenario folder and open the Pre simulation Learning Resources and Post simulation Learning Resources folders for the desired scenario For detailed instructions on activating these resources see the Using Student Faculty and Evolve Resources section of this guide page 46 You may elect to assign the student to review the patient s EMR prior to arriving at the simulation event In this case assign student access to the patient s EMR prior to simulation through the Post simulation Learning Resources folder see page 47 The student would review the EMR before patient care just as might be done during an actual clinical assignment The EMR contains data leading up to the scenario start time but like the pre simulation activities the EMR does not reveal any information about the patient s condition during the scenario so reviewing the EMR would not
99. nal When Maurice finished he accidentally spilled urine on the bed and floor While dealing with the urinal spill his nasal cannula fell off and he has since become short of breath During the scenario Maurice is quiet and cooperative but also frustrated and embarrassed about his loss of dignity and independence He is only able to speak in short four to five word phrases until his oxygen saturation improves and dyspnea resolves My birthday is February 22 I don t have any allergies During initial assessment If oxygen is administered and the head of bed is elevated If oxygen is administered but the head of bed is NOT elevated If oxygen is NOT administered but the head of bed is elevated Maurice is dyspneic and can only communicate in four to five word phrases 1 used the urinal deep breath tried to hang it on bedrail deep breath spilled it on bed and floor deep breath feel badly for making this mess deep breath my oxygen came off deep breath as reached for the urinal deep breath m sorry about the mess deep breath I m so embarrassed deep breath feel so weak deep breath Maurice s shortness of breath will resolve if oxygen is titrated to 4 L min or greater and the head of bed is elevated Oxygen 2 L min via nasal cannula O2 Sat 8996 I feel a little better deep breath but still can t catch my breath deep breath My wife died in the hospital
100. ncreased patient acuity the nursing shortage and the changing nature of the clinical unit As a means of addressing these issues clinical simulation has become an important component of nursing curricula Human patient simulators can respond physiologically to disease trauma and care very much like actual human beings would respond Recent advances in technology have greatly enhanced the capability of human patient simulators to replicate the types of situations that students are likely to encounter in clinical practice Clinical simulation provides a controlled environment in which students can practice the nursing process and sharpen their critical thinking and decision making skills before caring for real patients in the clinical setting During clinical simulation nursing students experience a realistic patient problem and use the nursing process to guide their interactions with the human patient simulator Students collect and analyze assessment data and intervene based on their understanding of the patient situation The human patient simulator is controlled by the simulation instructor hereafter referred to as the facilitator to respond to student interventions whether they are appropriate or inappropriate The human patient simulator can subsequently recover from the problem worsen or even die from a lack of intervention or as a result of an inappropriate intervention When using clinical simulation instructors may need to remind studen
101. ncy Department E Patient Education i Demographics i Consents Signatures ELSEVIER User Danny Witzofsky dwitzofsky Scenario 8 Sim Day Time Thur at 1600 Elsevier All rights reserved lt 8 Copyright O 2011 by Elsevier Inc All rights reserved AE es 42 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS A LABORATORY REPORTS Save Download submit Restart m Log off GIMULATION LEARNING SYSTEM MEN 7736871 Room 233 Age 60 Provider Patrick Cronin MD Code Statu Patient Maurice Arviso Gender Male Weight 155 Ib Allergies Full code Results of blood urine wounds fluids or any other lab results from the time of the patient s AAA admission will be found in the Laboratory KE a D Physician s Progress Notes DAY TIME Thu 1530 Reports section of the EMR By scrolling over faz the information icon to the left of the term a E 5 pop up box vvill reveal expected reference values Laboratory reports and studies requested during the simulation scenario will not be found in the Consults Procedures M History and Physical R Nursing Admission i Surgical Reports Emergency Department Patient Education Demographics il Consents Signatures i Hemoglobin i Hematocrit i Mean Corpuscular Volume i Mean Corpuscular Hemoglobin i Mean Corpuscular Hemoglobin Concentration i Red Blood Cell Distribution RDW i White Blood Cell Count 16 42
102. nd Diversity PREPARATION v SCENARIO v Debriefing Procedure Debriefing Procedure A well conducted debriefing session is integral to the simulation learning experience The best debriefing experience allows participants to openly reflect on the scenario in a non threatening and non judgmental environment The debriefing session should immediately follow completion of the scenario and should be conducted in a com fortable area with all scenario participants present The facilitator s role in debriefing is to provide structure to the discussion as students actively review and discuss details and outcomes of the scenario Facilitator s comments and reactions to student performance during the simulation should be kept to a minimum and student participants should be encouraged to lead the discussion as much as possible Reinforce the importance of the debriefing session and emphasize how this critical Allow students to discuss experience Debriefing Discuss student performance Review Pre simulation Exercises and lead Guided Discussion Provide remediation if needed Assign Post simulation Exercises and Post simulation Quiz Activate Post simulation Exercises and Post simulation Quiz Assign and activate any Skills Drills as needed re En a En Ed 33 RESOURCES Y DEBRIEFING RESOURCES v 4 PREVIOUS Screen 11 of 19 NEXT Actively participate in a nonthreatening e
103. nfection procedure recognized and accepted by reasonable physicians include None authorize the hospital to dispose of any severed tissue lunderstand that the practice of medicine is not an exact science and that consequently all medical procedures carry some risk understand that the procedure s described above may carry a material risk of infection 10 allergic reaction disfiguring scar severe loss of blood loss of function of any limb or organ paralysis or partial Surgical Consent Page 1 organs or body parts in accordance with the law and hospital policies lalso consent to diagnostic studies tests anesthesia x ray examinations and any other treatment or course of treatment relating to the diagnosis or procedures PE ni 4 GIMULATION LEARNING SYSTEM a Save Download Submit Restart E Log off MRN 7736871 Room 233 Age 60 Provider Patrick Cronin HD Code Status Patient Maurice Arviso Gender Male Weight 155 Ib Allergies H iT code gt i Identification Si ignatures Flovv Sheets A Medication Records INITIALS NAME A Nurses Notes Orders BD Braeden A Dobbins RN D Physician s Progress Notes PC Patrick Cronin MD aboratoryBaporta BR Benjamin Ryle MD _ Diagnostic Reports m C NE Consults Procedures A History and Physical A Nursing Admission i Surgical Reports Emergency Department V Patient Education Demographics i C
104. ng assignment may also serve as a guide for students as they complete the pre and post simulation exercises and quizzes Concept Mapping Using the Concept Map Creator designed to accompany the specific Ee 2 You can choose to enter pathophysiologic information related to the medical diagnosis This is optional nursing textbook students can create a concept 3 You can choose to enter up to four related risk factors related to the medical diagnosis This is optional map linking the patient s medical diagnoses MEDICAL DIAGNOSIS clinical manifestations collaborative problems pathophysiology risk factors nursing diagnoses interventions and expected outcomes The con HY e Enter patho iologic information rela o the medica cept map can be saved as a final draft saved for TO as A a D oe future modification or printed EE a PATHOPHY Enter up to four related risk factors related to the medical diagnosis This is optional Pre simulation Exercises are meant to encourage higher level thinking in the nursing student and should be completed before the simulation experience The exercises reinforce concepts related to the nursing process pathophysiology patient education and other issues that may be pertinent to the elements of the scenario without revealing the specifics related to the scenario These exercises can be performed independently or in a group setting led by a facilitator Once completed the stud
105. nt v Safety amp Hygiene v Restraints i Nurses Notes Orders DAY TIME Day Thu 1630 Thu 1530 Thu 1430 Physician s Progress Notes hh mm Vital Signs Assessment il Laboratory Reports Diagnostic Reports Consults Procedures i TEMPERATURE F 102 1 102 4 il History and Physical a Nursing Admission i TEMPERATURE C 38 9 39 1 i Surgical Reports i TEMPURATURE MODE OF Emergency Department V ay a MEASUREMENT Patient Education i SYSTOLIC BLOOD PRESSURE 127 130 il Demographics i Consents i DIASTOLIC BLOOD PRESSURE 73 72 Signatures i BP MODE OF MEASUREMENT c i HEART RATE 96 96 y i RESPIRATORV RATE 24 24 v ELSEVIER v of each assessment item Each subcategory within the Nursing Flow Sheet section is described in detail below Vital Signs This interactive page contains information regarding the patient s temperature blood pressure pulse respirations oxygen saturation blood glucose height and weight as well as other vital measure ments These fields will be populated up to the time of the scenario start according to the patient s hospital stay Students should reference this page to determine the patient s baseline vital signs detect trends in the values and document findings noted as part of the care administered during the simulation scenario Pain This interactive page contains information regarding the patient s report of pain according to the pain rating sca
106. ntended to provide the student with information such as clinical findings or data while other responses such as questions about interventions are intended to challenge or cue the student to interact with the patient Responses are organized into categories so that the facilitator can quickly locate the appropriate response The Patient Response Guide has been scripted to reflect the patient s clinical condition and antici pated issues These general responses are provided as a framework with the understanding that stu dent questions and actions are often unpredictable The facilitator is encouraged to improvise and add appropriate impromptu responses on behalf of the patient when necessary Patient Response Guide Maurice Arviso Maurice Arviso is a 60 year old Native American male admitted to the hospital with pneumonia He is a kind hearted soft spoken man He does not want to be a burden to anyone and tries to do everything independently He is used to a full and busy life as a retired craftsman and loves to make wooden toys for his grandchildren Both Maurice s wife and his father passed away while in a hospital His wife died one year ago and his father passed away at age 55 after developing a cough Maurice is anxious about his current illness and is troubled by the idea of dying in a hospital like his loved ones Just before the scenario started Maurice asked his son Jonathan to step out so that he could use the uri
107. nvironment for reflective learning self group and instructor and constructive feedback Integrate prior nursing knowledge and skills Validate behavior attitudes and actions manifested during the simulation Model critical thinking and clinical decision making FE Observer Evaluation Rubric Debriefing Reflection Guide and Guided Discussion Textbook Potter and Perry Student Resources Multimedia Resources Skills Drills 4 PREVIOUS NEXT reflective process correlates with enhanced learn ing outcomes The debriefing should last as long or longer than the scenario itself Copyright O 2011 by Elsevier Inc All rights reserved 34 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Debriefing Reflection Guide PREPARATION v SCENARIO v Debriefinq Reflection Guide DEBRIEFING v RESOURCES 4 PREVIOUS Screen 12 of 19 NEXT The Debriefing Reflection Guide is organized into 5 phases to help you provide structure to the pebriefing is an integral part of every quality e simulation The best debriefing experience allows the debr iefing process The phases include students to discuss digest and discover The NL facilitator s role in debriefing is to guide the discussion 1 Student Reaction and to keep the conversation on topic However the la facilitator s comments about the simulation should be Student Reflection kept to a minimum The student participants sho
108. of action and nursing considerations related to the medications in addition to asking the stu dent to provide the rationale for the medication order Copyright O 2011 by Elsevier Inc All rights reserved qEE E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Nurses NOTES This portion of the EMR contains the narrative nursing notes which begin at the time of patient admission Any information that cannot be ade quately described in the nursing flow sheet should be documented in narrative format in the Nurses Notes to supplement the flow sheets Students can add their narrative documentation of the events that occurred during the simulation scenario such as detailed assessments patient interventions and the patient response to the particular intervention The facilitator should instruct students to write detailed nursing notes regarding the simulated patient experience Thorough documentation of 41 User Danny Witzofsky dwitzofsky Scenario 8 Sim Day Time Thur at 1600 Save 2 Download E Submit W Restart Log off 3 GIMULATION LEARNING SYSTEM MEN 7736871 Room 233 Age 60 Provider Patrick Cronin MD r Code Status Patient Maurice Arviso Gender Male Weight 155 Ib Allergies Full code Identification i Nurses Notes Flow Sheets R Medication Records DAY TIME NURSE S NOTES NURSE SIGNATURE 3 J Nurs
109. ollowing Chief Informant Chief Complaint History of Present Illness Allergies Family History Past Medical History Social History Current Medica tions Immunizations Review of Systems Physical Exam Impressions and Plan The history and physical is completed by the primary health care provider when the patient is admitted therefore this information cannot be modified by the stu dent With the history and physical data serving as 43 Bis MRN 7738876 Room 313 Name Jesus Garcia WOUND OSTOMY CARE CONSULT NOTE Michael Levin MD Wound ostomy care Wed 0745 Reason for Consultation 15 days post temporary loop colostomy Referral Source Michael Levin MD History of Present Iliness Patientis a 28 year old Hispanic male who presented for direct admission to hospital after experiencing nausea and decreased oral intake for the past 5 days Patient has a long history of moderate left sided colitis unresponsive to medical therapy He undervvent elective colectomy and transverse loop colostomy 15 days ago and was discharged home 5 days ago He received TPN postoperatively for bowel rest but now presents with nausea vomiting and vveakness Denies any blood in colostomy bag States that stool has consisted of a large amount of effluent with some semiformed material Ostomy location Leftupper quadrant just left of midline abdomen Wound Ostomy Care Consult Page 1 Save Download Submit jRestart DI
110. om three locations From the icon on the scenario header bar e From the link on the Implementing the Simula tion Experience screen From the scenario specific Facilitator s Packet The RN to RN Patient Report provides students with a current patient status update and sets the stage for the scenario Facilitators may choose to present the report to their students themselves or to have a student play the role of the nurse provid ing the report The report may be reviewed in writ ten form read aloud as if in a report room or communicated at the patient s bedside Regardless of the delivery method this report must be pro vided to students before the start of the scenario 23 L RN to RN Patient Report SBAR Hand Off Current day and 1600 Thursday time Situation Name Maurice Arviso Age 60 Sex Male Ethnicity Native American Religion Christian Provider Patrick Cronin MD Admission Pneumococcal pneumonia diagnosis Background Pertinent medical Mild arthritis history Pertinent social Widowed with one living son history Allergies No known allergies Code status Full code Vital signs most recent Oxygen therapy Pain Other recent Cefotetan 1 g administered IV at 1530 medication Azithromycin 500 mg administered PO at 1530 IVs Fluid Dextrose 5 in lactated Ringer s solution at Labs and diagnostics
111. onsents Signatures Elsevier All rights reserved User Danny Witzofsky dwitzofsky Scenario 8 Sim Day Time Thur at 1600 1 Copyright O 2011 by Elsevier Inc All rights reserved AE es 46 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Using Student Faculty and Evolve Resources PRE SIMULATION LEARNING RESOURCES Wine ba eno adde JPre simulation Learning Resources environment students also need preparation in order to maximize their time in simulation You may elect to have students do all some or none of the pre simulation assignments Students who complete these assignments independently can submit their responses electronically to the facili tator Y Scenario 8 Pre simulation Quiz Scenario 8 Reading Assignment Y Scenario 8 Pre simulation Exercises Reading Assignments offer relevant content in your obstetric nursing text that will help students prepare for the scenario These textbook readings correlate specifically with the learning outcomes for each simulation scenario Before the simulation experience the facilitator may assign general readings so that students can prepare adequately for the events that may occur in the simulation scenario without revealing the specific storyline of the scenario Students who are adequately prepared for the simulation scenarios can use this foundational knowledge and build on it during the scenario thus honing their critical thinking abilities The readi
112. oses and to develop related patient goals Suggested answers are provided to the facilitator to assist in leading the discussion PREPARATION v Guided Discussion Questions 35 SCENARIO v DEBRIEFING v RESOURCES v 4 PREVIOUS Screen 13 of 19 NEXT gt Click each question to view or hide its possible answers rationale textbook references and remediation resources Maurice Arviso states I am short of breath What assessment findings should the nurse obtain based on his statement Possible Answers Guided Discussion Nursing Diagnosis Lung sounds in all lobes Pulse oximetry Posture of patient Quality of breathing respiratory rate Temperature Pulse rate Level of consciousness Capillary refill Color Presence of secretions Subjective data Rationale pp 917 There are many components included in the physical assessment of a patient with a diagnosis of pneumonia The focus is on perfusion Remediation Reading Assignment Thorax and Lungs pp 592 598 Hypoxia p 917 Physical Examination pp 921 922 Multimedia Resources Assessing Apical Pulse Assessing Radial Pulse Understanding the Purpose of the Pulse Oximeter Using a Pulse Oximeter 2 What questions would be appropriate for a nurse to ask when gathering subjective data from a patient with a history of a cough 3 What assessment data should the nurse collect regarding the patient s sputum 4 Priorto the start of the scenario a nu
113. ownloaded and printed from the Preparing Yourself screen or accessed by clicking on the quick access icon IA in the upper right hand corner of the Implementation Module screen The icon F appears throughout the Implementation Module next to any specific resources that can be found within the Facilitator s Packet FACILITATOR S PACKET The Facilitator s Packet contains the Scenario Overview Staging Instructions Identity Bands RN to RN Patient Report Patient Response Guide Additional Participant Response Guide s Participant Role Badges Observer Evaluation Rubric Algorithm Quick Card and Performance Checklist The Scenario CIMULATION LEARNING SYSTEM TUE Scenario 8 Oxygenation and Hygiene The scenario purpose overview and time limit is yg yg the same as that found on the Scenario Overview screen under the Preparation tab Purpose To provide students with the opportunity to assess plan prioritize and implement nursing care for a patient experiencing dyspnea and loss of independence Overview Maurice Arviso is a 60 year old Native American male directly admitted from his provider s office to the inpatient medical unit with community acquired pneumonia Maurice is deter mined to maintain his independence and dignity and refuses assistance with personal care even though he experiences shortness of breath with any exertion Just before the scenario begins Maurice attempts to use the urinal independently and spills urine on the
114. pnea and loss of independence Recommended scenario time limit 20 25 minutes Recommended debriefing time limit 20 25 minutes NEXT Copyright O 2011 by Elsevier Inc All rights reserved Na 16 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS SLS Implementation Module The SLS is set up identically for each scenario Once you become familiar with how the materials are organized for one scenario you ll easily be able to navigate through the rest The following sections detail the SLS resources available within each scenario Implementation Module IMPLEMENTATION MODULE OVERVIEW Each scenario Implementation Module is organized into four main tabs that house the preparation scenario debriefing and supplemental resources for the scenario Within these tabs you will find all of the instructions details and resources necessary for implementing the scenario i e E SIMULATION LEARNING SYSTEM Oxygenation and Hygiene PREPARATION SCENARIO Y 2 DEBRIEFING Y RESOURCES 1 Preparation resources are for pre simulation planning and preparation 2 Scenario resources assist during simulation implementation 3 Debriefing resources facilitate discussion and evaluation post simulation 4 Resources are additional items to facilitate student understanding In addition to these four main tabs five quick access icons are
115. r Students who complete these assignments online can sub mit their responses electronically to the facilitator for grading and feedback Y Scenario 8 Post simulation Exercises Documentation EMR Documenting patient care is a fundamental nursing skill Before during and after the simulation event the student can practice referencing and documenting care in the EMR When students document in the EMR under their specific login the data is saved only to that particular student account When logged into the EMR students have the option to save data and return to the patient chart to complete documentation at a later time or to submit the chart electronically to the facilitator for review A Care Plan Constructor guides the student in g care Plan Constructor the creation of a care plan that they can cus sont Cee x tomize for the patient The Care Plan Construc tor allows the student to identify nursing diag noses using NANDA NOC or NIC format and outline evidence based nursing interventions appropriate for the patient The student may then save or print out the customized care plan Savel Open Revert Delete Saved Plans Create Printable Page k Nausea Betty J Ackley EdS MSN RN NANDA Definition A subjective unpleasant wavelike sensation in the back of the throat epigastrium or the abdomen that may lead to the urge or need to vomit Defining Characteristics Aversion to food gagging sensation increased
116. re Ulcer Risk Assessment Treating Pressure Ulcers Wound Assessment Dry Moist Dressing Application Wound Irrigation Binder Application Elastic Bandage Application Dressing Change Heat and Cold Therapy Wound Culture _JHeat and Cold Therapy 1 Student Challenge Ki EMR Heat and Cold Therapy 1 ad Video Demonstration leLange is a 65 year old male with cellulitis of his left foot which is infected with MRSA The physician was just in and added an order for a oist compress to his left foot Verify the order in the EMR and perform the intervention Document your care in the EMR Readings Potter amp Perry Basic Nursing 7 Edition pp 1087 1088 1103 1104 Potter amp Perry Current day amp time Fundamentals of Nursing 7 Edition pp 1335 1338 Wednesday 1600 Elkin Perry amp Potter Nursing Interventions amp Clinical Skills 4t Edition pp 543 547 Copyright O 2011 by Elsevier Inc All rights reserved Na 8 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS The EMR is an integral element of each skills drill While students can review the record before arrival to the lab access to the EMR within the lab setting is essential for successful completion of the drill challenge Most Skills Drills direct students to review the EMR prior to initiating the challenge Students will need to review
117. re quickly Therefore it may be helpful to allow extra time when scheduling These times are estimated based on SLS field testing Copyright O 2011 by Elsevier Inc All rights reserved Na 18 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Performance Objectives The Performance Objectives consist of identifi able actions that the student should perform during the scenario or after in the debriefing discussion These objectives are based on the nursing process and are organized according to the Quality and Safety Education for Nurses QSEN quality and safety competencies Specific nursing actions are listed in the Performance Objectives section to guide the facilitator in choosing the most appropri ate simulation scenario for the student s skill level The Performance Objectives correlate closely with the objectives in the Performance Checklist see page 27 However the checklist has been organized chronologically for trouble free student evaluation Patient Data The patient s name medical record number date of birth gender admitting health care provider chief complaint upon admission to the health care facility and primary and secondary diagnoses are listed here closely mirroring the medical record in the real world clinical environment Scenario Start Day and Time The scenario start day and time reflect the exact time tha
118. recautions Utilize therapeutic communication Provide patient and family education Access and document care in the EMR Receive report including current blood glucose level Assess patient Administer SQ insulin according to scheduled dose plus correction scale order Conduct wound care per order Provide patient education and support Access and document care in the EMR Simulation Presentation Patient Diagnoses Patient with history of ulcerative colitis and transverse colostomy is admitted with dehydration Primary diagnosis Dehydration Secondary diagnosis Ulcerative colitis status postpartial colectomy with transverse colostomy Patient with a history of falls is admitted with dizziness and a mechanical fall Patient is incontinent of urine and has limited mobility Primary diagnosis Hypotension Secondary diagnosis Mechanical fall Patient with a history of laryngeal cancer a permanent tracheostomy and continuous supple mental oxygen is admitted with pneumonia Patient is in contact isolation for MRSA in her sputum Primary diagnosis Pneumonia Secondary diagnosis Laryngeal cancer tracheostomy Patient with a history of type diabetes mellitus and a stage II non healing foot ulcer is admitted for diabetic management and wound care Primary diagnosis Stage 1 non healing ulcer on right heel Secondary diagnosis Diabetes mellitus type Copyright O 2011 by Elsevier Inc
119. reen of the Scenario tab Copyright O 2011 by Elsevier Inc All rights reserved SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 17 1 PREPARATION GIMULATION LEARNING SYSTEM Bn em OH Era Oxygenation and Hygiene PREPARATION ie SCENARIO FT DEBRIEFING RESOURCES Y Scenario Overview Performance Objectives Patient Data Preparing Yourself e Preparing Your Students e Preparing the Setting Scenario Overview GIMULATION LEARNING SYSTEM Fa Em ur IW Ed Title The scenario title located just to the left of Orogenation and Hygiene the quick access links reflects the patient s med sico Sco ical condition For students scenarios are referred to by number and patient name only so as not to reveal too much about the simulation experience AS Screen 01 of 19 NEXT Purpose To provide students with the opportunity to assess plan prioritize and implement Pu rpose The scenario purpo se reflects the nursing nursing care for a patient experiencing dyspnea and loss of independence o actions that the student will perform during the Scenario This purpo se clo sely mirrors the nursing admitted from his provider s office to the inpatient medical unit with community acquired pneumonia Maurice is determined to maintain 4 his independence and dignity and refuses assistance with personal pr OCCSS 1n that the student must assess plan care ev
120. rge When these specifications cannot be met with standard simulator settings it may be necessary to improvise in order to create the best possible simu lation environment Suggestions for alternative moulage or equipment work arounds have been supplied when available Following the guidelines where possible and using creativity when the guidelines cannot be followed will ensure a quality simulation learning environment for your students Because the EMR is an essential component of patient care it is necessary to provide internet access for student access to the EMR during the scenario Access to the EMR will allow students to review patient data or reference orders during the scenario as well as to practice documentation during or immediately following the scenario Copyright O 2011 by Elsevier Inc All rights reserved Na 22 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Identity Bands In order to closely mimic the real life clinical environment the Facilitator s Packet provides Identity Bands appropriate to the scenario Provided bands include Patient Identity Allergy and other Risks Alerts Correct identification of a patient reduces the risk for errors in the clinical setting Utilizing these bands during simulation allows students to practice this skill with each scenario in order to promote patient safety The bands are designe
121. rgency Department w Flow Sheets a Medication Records Patient Name Bernadette Jackson a Nurses Notes Age 85 Birth Date May 10 Gender Female Orders Arrival Thur 1130 Mode of Arrival Ambulance Referring Facility NA Date Time Physician s Progress Notes Chief Weakness lethargy Laboratory Reports Complaint Diagnostic Reports T 99 2 F 37 3 C P 86 R 22 Consults Procedures BP 140 70 WT 55 kg a History and Physical Initial Emergency medical team called to Mrs Jackson s home after a friend found her lethargic and weak Assessment there Patient in no acute distress on arrival Vital signs stable Lethargic but arousable with verbal a Nursing Admission e stimuli Complaining of lower abdominal pain Mild diaphoresis noted i Surgical Reports Care prior to i IV angiocatheter 18 gauge placed in right forearm in the field and 250 mL bolus of 0 9 normal arrival jj Emergency Department saline given A Patient Education Medication History Allergies Demographics Medication Dosage Freq Started Allergy Allergic Reaction i Consents Oxybutynin 5mg 3 times per day Thur 0600 No known drug allergies Signatures Loratadine 10 mg Daily Thur 0600 Vital Signs Pain Time Temp Blood Pressure Pulse Resp Time Scale 1330 99 6 140 68 80 22 1330 NPI 3 ELSEVIER 1300 99 4 144 68 Ivina 138 64 sittina 122 62 82 Ivina 88 sittina 112 22 1300 NPI 4 User Danny Witzofsky dwitzofsky Scenario 2 Sim Day Time Thur at 1500 E
122. rinal bottle Optional Reference materials e g lab book drug book Simulated clear light yellow urine suggestion use normal lab values water or lemonade if there is concern about yellow food coloring staining sheets or floor Bed pads x 2 Clean top sheet Towels Disinfectant wipes Trash bin Linen bin or bag Patient call light Patient identity band EMR Prepare the adult simulator to reflect the specifications of the scenario 10 11 12 13 14 15 Position simulator crooked in bed with legs hanging off the side of the bed and the head of bed fiat Change simulator to male gender Apply correct identity band to simulator Insert IV angiocatheter in right hand secure with dressing and infuse 1000 mL IV bag of dextrose 5 in lactated Ringer s solution via IV pump or gravity at 75 mL hr If adding optional completed secondary IV tubing to scene connect empty secondary IV bag of cefotetan to primary line via secondary IV tubing Twist linens to appear disheveled Place pillows in disorganized manner on bed and or on floor Place nasal cannula on floor or bed out of patient s reach not on patient Connect tubing to oxygen flow meter at 2 L min Place call light on floor or bed out of patient s reach Pour small amount of simulated urine on top sheet and bed pad and on floor next to bed Fill urinal with small amount of simulated urine and place urinal on its side on the floor at pat
123. rio 8 Sim Day Time Thur at 1600 lt Save Download Submit Restart Log off Code Status Full code GIMULATION LEARNING SYSTEM MRN Patient 7736871 Maurice Arviso Room 233 Age 60 Gender Male Weight 155 Ib Provider Patrick Cronin MD Allergies Identification S 8 i Identification b Flovv Sheets MRN Medication Records 7736871 Pi i i g Nurses Notes atient Name Maurice Arviso d 5 Room 233 a Physician s Progress Notes Gender Male jj Laboratory Reports Age 60 Diagnostic Reports Provider Name Patrick Cronin MD Consults Procedures Primary Diagnosis Pneumococcal pneumonia History and Physical Secondary Diagnosis None Nursing Admission Allergies No known allergies 8 Surgical Reports Height 5 ft 11 in g Emergency Department Weight at admission 155 Ib A Patient Education Code Status Full code Demographics i Consents Signatures ELSEVIER Elsevier All rights reserved 5 gt Save 2 Download Submit Restart Log off Code Status i Full code Additional Help GIMULATION LEARNING SYSTEM MRN Patient 7736871 Maurice Arviso Room 233 Age 60 Provider Patrick Cronin MD Gender Male Weight 155 Ib Allergies i Identification Fl ow Sheets Flow Sheets A Medication Records Vital Signs Pain Intake amp Output e IV Therapy Special Monitoring System Assessme
124. rithm Quick Card 13 Instructor uses the Patient Response Guide to act as patient 14 Instructor evaluates student performance using the Performance Checklist 15 Non participating students evaluate student performance using the Observer Evaluation Rubric 16 Students document care during and after the scenario using the Electronic Medical Record 17 Instructor signals end of scenario 18 Instructor leads scenario debriefing and guided discussion using the Debriefing Procedure Debriefing Reflection Guide and Guided Discussion material 19 Instructor activates student Evolve access to post simulation activities as desired Electronic Medical Record Care Plan Constructor Journaling Interdisciplinary Communication Post simulation Exercise and Post simulation Quiz 20 Students access Evolve to complete the assigned post simulation activities 2 Instructor evaluates student work in the Evolve gradebook and communicates feedback to students p 77 00 Copyright O 2011 by Elsevier Inc All rights reserved A E A arx n n SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 5 SLS Skills Drills SLS Skills Drills is a new feature added to the SLS to provide an opportunity for students to practice discrete skills outside of the multifaceted context of an SLS scenario Skills Drills are designed so that they can be set up by the instructor or learning laboratory personnel for students to complete with or without supervision The
125. rse took a telephone order and documented telephone order read back in Maurice Arviso s EMR What is the proper procedure for taking a telephone order and how does this procedure promote patient safety Describe the objective manifestations of dyspnea 4 PREVIOUS NEXT gt PREPARATION v SCENARIO v DEBRIEFING RESOURCES v 4 PREVIOUS Screen 14 of 19 NEXT gt 1 Ineffective role performance related to hospitalization as evidenced by verbalization independence of loss of i Patient Goal e The patient will participate in recovery care during hospitalization Text Reference p 419 Ineffective airway clearance related to inability to clear secretions as evidenced by presence of thick secretions and decreased oxygen saturation levels Patient Goal The patient will effectively clear airway of secretions during hospitalization The patient s upper lung fields will be clear to auscultation during hospitalization The patient s pulse oximetry will improve The patient s respiratory rate will be between 12 and 20 The patient s pulse oximetry value will remain greater than 9296 Text Reference p 926 4 PREVIOUS NEXT Copyright O 2011 by Elsevier Inc All rights reserved Na 36 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Guided Discussion Patient Teaching Patient teaching points related to each scenario are include
126. s Vital signs Assessment Skin integrity and wound care Communication Delegation Documentation and informatics Concepts Vital signs Postoperative assessment Communication Skin integrity and wound care Patient education Documentation and informatics Scenario Skills Assess patient Recognize physical assessment findings within normal parameters Notify provider using SBAR Manage unit distractions calls interruptions Delegate tasks appropriately Maintain patient s privacy in compliance with HIPAA regulations Utilize therapeutic communication Provide patient and family education Access and document care in the EMR Receive report from PACU Conduct postoperative assessment Recognize moderate surgical site bleeding Notify provider using SBAR Reinforce surgical dressing per provider order Utilize therapeutic communication Provide patient and family education and support Access and document care in the EMR Scenario and debriefing times are estimated based on field testing results Simulation Presentation Patient Diagnoses Patient with cellulitis of the forearm is admitted for antibiotic therapy and monitoring Patient is stable and ready for discharge after learner conducts an assessment and notifies provider of stable status Primary diagnosis Cellulitis Patient with a ruptured appendix undergoes an urgent appendectomy The patient is discharged from post anesthesia
127. s jjuep CL R05 So EOIBINS JO XSL v SINPIY L eo SIIRPE pezijeuonninsur ul eseesip esooyounaud pue ezuenjjul JO su eu SINPIY DL L09 SEL uo Bunjnses uueu juened jo ysi v SINPIY 6 L09 SUOIJ29JUI D EBIOOSSE sued yyesy JO eu au np M LIBO 205 jajes 3uaneg jJeuoneN 01 02 P el M eoueuuoJied jenpinipul pue SS U ANO H ulejs s uyoq uBnouui sJepi oJd pue sjuaned o wey JO YSL ZIWIUIN jojes yyesy euundo jo ISM 9P 104 sen eA pue seouaJ9JaJd Ajiuejuened pue esnjedxe jesuo YIM eouepi oe 4 1999 peseg o2uopi 3 S l u dulo2 NASH P El M s 9 npa20 4 sjuaueaJ s jse omsouBelg jo SuOnEo OLdulo2 104 Jenuejoy seJnpeooJgd onnedeJjeu sulejis g pog ui suoneJejyv 104 JENUSIOg sjuauissessy ouyioedg 9 S nIBA Asoyesoge suoneJej v pue senpeooJg leoi5ins wo suoneoijduio2 JO S S9 onsouDeiq SUDIS 1 ui senijeuuouqyv seDueu 0 Dau jou SI ING sepnjoui juajuoo pajejay SeJnpeooJd JO sjueuueaJ suonipuoo Bunsixe o sulie qoud uyeeu Jo suohyeolldulo doje ep IM sjuened yey poo ll yil 94 Buronpes TVILLN3 LOd MASIY 40 NOILORnG3H AYOOALVIANS eX319N suoneJeye uyeeu BuiDeueuiJ pue enuajod ysi 1uened BuronpoJ Hojuioo pue ales BulplAoid Aq ss ull M pue yyesy eorsAud sejououd esunu 8eu 4 11H91 NI 12190 10ISAHd AMOO3
128. s interactive portion of the EMR students MedeaionRecors 1 can review medications administered since the AA unm 7 patient s admission and document all medications ES 757 administered during the simulation scenario __ Medication administration errors are among the Consta roce ANN 1530 most common preventable medical errors The ce p Medication Records allow students to practice the css cuss ES By roith skill of proper medication administration which Less mmm 769 mM will enhance patient safety in the clinical setting E um The student can carefully reference medication nh so to orders check for medication allergies and prac s 2077 tice implementing the six rights of safe medica la tion administration in the simulated clinical setting Practicing in the simulation lab will enhance student performance of these important skills Only medications ordered and administered before the start of the scenario will be included in the Medica tion Records During the course of the scenario if a new medication is ordered or administered students can enter the medication order in the Orders and the Medication Records section and document that the medication was administered Once the medication is administered the time appears as a strikethrough in the record The facilitator can use the Medication Records list to facilitate discussion of the classification mechanism
129. scussions of the importance of therapeutic communication with both the patient and family member or friend should be encouraged the guide to provide appropriate responses and i uu of bed is elevated Ancillary Personnel Student participants in ancillary personnel roles such as the secondary nurse or nursing assistant should be instructed to provide care within that provider s scope of practice If indicated in the response guide or to guide the direction of the scenario the facilitator should prompt the secondary nurse and assistive personnel to enter the room or conduct a certain action depending on the events occur ring in the scenario In most scenarios no response guide is provided for ancillary personnel unless a specific action is required of that person during the scenario Students in ancillary personnel roles are expected to take direction from the primary nurse and complete tasks appropriately It may be challenging for some students to maintain an ancillary role during a scenario when they are accustomed to acting as a nurse students should be reminded during orientation to limit their interventions to the scope of practice of the ancillary care provider during the simulation Issues that arise during simulation related to an individual s scope of practice and responsibilities during patient care may make for rich discussion during the debriefing session Physician or other Health Care Provider q Additional Participant Re
130. se mini scenarios focus on the application of a single skill within the context of a patient situation The patient context for each drill encourages basic critical thinking rather than the simple memorization of skill steps In addition several variations of each skill are provided facilitating skill procedure discernment In addition to helping prepare students for an SLS scenario Skills Drills may be used for e Student practice after initial skill instruction e Student self testing prior to instructor mediated skill testing e Student skill practice prior to a clinical experience e Student remediation Competency testing of student skill performance The Skills Drills folder contains an entire library of drills appropriate for the fundamentals SLS course Some of the drills are geared specifically to SLS scenarios while others are meant for general skills practice In all the fundamentals Skills Drills library consists of 270 independent skills drills SLS SkiLLs DRILLS RECOMMENDED PROTOCOL The following is the recommended protocol for integrating Skills Drills into the SLS experience This pro tocol provides the steps for implementing Skills Drills as preparation for an SLS scenario Individual steps of the protocol may be modified as desired to maximize the use of Skills Drills in your academic setting 1 Instructor views the Skills Drills recommendations from the menu of the selected SLS scenario 2 Instructor reviews the Skills Drills
131. sive set of resources to assist both nursing educators and students Developed reviewed and tested by nationally recognized simulation and nursing education experts the SLS protocol emphasizes the teaching and learning possibilities of clinical simulation By following this process students and instructors alike can gain the maximum benefits of the simulation experience Copyright O 2011 by Elsevier Inc All rights reserved 1 auqpmm P U n 2 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Students complete pre simulation quiz get patient reports and review charts Students complete reading assignment Simulation Center Lab Schedule Choose participants Assign roles students for Assign participants simulation Give report E Students complete reading assignment and pre simulation activities Students complete post simulation activities and quiz The SES contains a library of clinical simulation scenarios featuring patients with a variety of conditions Each scenario 1s accompanied by a complete electronic medical record The clinical simulation experience begins with pre simulation activities that prepare the student to enter the simulation laboratory progresses to the simulation experience as the student provides
132. specially helpful for your nursing program to enlist one or more champions of clinical simulation as experts in the implementation of simulation and to coordinate clinical simulation activities with other facilitators Copyright O 2011 by Elsevier Inc All rights reserved Na 20 915 IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS The Staging Instructions provide detailed infor mation regarding the scenario specific props including equipment supplies and medications necessary for scenario implementation Instruc tions regarding the use and placement of these props for scenario staging are included In some scenarios paper resources or forms will be required as props Any required resources or forms are included within the Facilitator s Packet and appear as links in the Preparing the Setting screen of the Implementation Module Simply click on the link and print the required materials Staging Instructions Equipment supplies Medications IV angiocatheter 22 gauge with pigtail extension tubing 1000 mL IV bag of dextrose 596 in lactated Ringer s IV dressing supplies solution IV primary tubing Acetaminophen 650 mg tablets distracter IV pump optional instead may control rate via roller no medications needed during scenario clamp tubing Aspirin 81 mg tablets distracter 2 or 3 pillows Nasal cannula and tubing U
133. sponse Guide Students should be infor med dur ing OT jentation to contact the physician as the patient s condition will improve if oxygen is administered and the head of bed is elevated However the student may decide to call if the wrong interventions are chosen and the patient s that they may need to contact the p atient S physi condition deteriorates Dr Cronin is Maurice Arviso s physician but he is unavailable Dr Campbell who does not know Maurice is covering for him cian or other health care provider to provide a If SBAR report is not Please give me more information about status update or to obtain verbal orders during the 575 your assessment course of the scenario Communication may be your recommendation obtained through line p aging system Ge Ke maintain oxygen saturation levels greater in per son communication OT two way walkie respiratory therapy to evaluate him l will be up to see him in a few minutes talkies depending on the scenario and your simu lation facility s design and resources The role of the health care provider should be played by a facilitator or faculty member using the Additional Participant Response Guide for reference Advance practice nursing students medical students or other similarly prepared students may also play this role in general it is not advisable to have n
134. ssassy eois ug jo UOHU A Lci eseesiq uonouloJd UHE H SSeu oAM pue ujeaH jo sejdiouud suonisueJ pue seDejg jejueuildoJa e S92IOU H S H 9 87 UJOQMAN pue unledisoy e u auuy SJO NBy9g de UBIH ssooold BUIBY 0 JOU s nq sepnjour juejuoo pajejay uyeoeu eundo analyse o sei ejeujs pue suje qoJd yyesy jo uonoosjep AHE Jo pue uonyuanald sejdiouud 1ueuudoj o ep pue jo aBpajmouy ay 2 zey sJeuyo zueu IS ARE pue juened ay jo eJeo Duisunu sjoeJip pue sinu 8Y JONVNALNIVIN ANY NOLLONOMa H LTV3H AHOO31VO eX319N 39NVN3LNIVIA ON NOLLOWO3d HLTV3H p JU0I I1IGNY uonenj eA 3 Copyright O 2011 by Elsevier Inc All rights reserved 60 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS uone ndod juaned ul jueJeuur deu jajes Ainu pi CL Log baje s jejes juoened e se ag umo 11y ui jueuleA oAur sjuened abelno9uy CL Log 61200 Ajyayes Ued jeuoneN 010Z POLIH 8J62 yyesy euundo jo ISM 9p JOJ SAN eA pue seouaJoJaJd jiuej juened pue esiiedxa jelu ym eouepi e 4 1999 a e103 U peseg o2uopi 3 Speeu pue senj eA sagualajald s uened 104 0 48 uo paseq pejeuripjyooo pue ejeuoisseduuoo ul Jeujied pue o uos jo e2Jnos y se eeuBis
135. stant flow e Attempt to reach goal volume e When maximal inspiration is reached hold breath for 3 to 5 seconds e Exhale slowly Text Reference p 928 942 1381 1383 4 PREVIOUS NEXT gt PREPARATION SCENARIO v DEBRIEFING RESOURCES Y Guided Discussion Growth and Development 4 PREVIOUS Screen 16 of 19 NEXT 1 Developmental Stage Middle adulthood age 36 65 Erikson psychosocial development stage Generativity versus self absorption and stagnation Key Points e Some adults suffer the loss of status and function e May suffer loss of significant people in their lives e Maintaining independence is important to one s self esteem Maurice Arviso is having difficulty adjusting to his current health problems and lack of physical strength He has not accepted his dependence on others for personal care He will need to find ways to maintain his quality of life while recovering from this illness Text Reference p 139 2 Gerontologic Considerations Aging and the cardiopulmonary system Key Points e Decreased respiratory muscle mass and chest wall compliance Decreased alveolar surface area Decreased responsiveness of central and peripheral chemoreceptors to hypoxemia and hypercapnia e Decreased number of cilia e Decreased IgA production and humoral and cellular immunity Text Reference p 922 Reference Edelman and Mandle Health Promotion Throughout the Life Span 7h Edition St Louis 2010 Mosby 4 P
136. sts User Danny Witzofsky dwitzofsky Scenario 8 Sim Day Time Thur at 1600 lt Jl 2 Download E Submit n Restart Log off J GIMULATION LEARNING SYSTEM d com e rovider Patrick Cronin le Status MRN 7736871 Ri 233 Age 60 Provider Patrick C in MD Code Stat Patient Maurice Arviso Gender Male Weight 155 Ib Allergies Full code Identification i Orders A Flow Sheets A g Medication Records DAY TIME ORDER TYPE ORDERS SIGNATURE g Nurses Notes Day at m per dh gj orders hh mm Y i Physician s Progress Notes a Laboratory Reports Linked Forms Diagnostic Reports Thu 1530 Telephone 1 Cefotetan 1 g IV every 12 hours first dose T O R B order now Braeden a ES read back 2 Azithromycin 500 mg by mouth daily first Dobbins RN a History and Physical orders dose now confirmed Nursing Admission z R c B A 9 Thu 1430 Admission 1 Admit to medical unit Patrick Cronin g Surgical Reports orders 2 Diagnosis Pneumococcal pneumonia MD 3 Code status Full code il Emergency Department 4 Vital signs every 2 hours for first 8 hours then R every 4 hours j Patient Education 5 Continuous pulse oximetry 3 6 Strict intake and output a Demographics 7 Activity As tolerated c e 8 Diet Regular cM 9 Complete blood cell count with differential a 10 Sputum culture call with results m Signatuas 11 Portable anterior posterior chest x ray on admission 12 Oxygen v
137. t the student encounters the patient during the simulation scenario The corresponding EMR reflects patient data collected up to the start time of the scenario again recreating the real life clinical environment Students have the opportunity to document in the EMR the events that occur during the scenario beginning with the start day and time Preparing Yourself Preparation is the key to success in clinical simu lation and ensures that the simulation scenario runs smoothly for you and your students Before running an SLS scenario with students you should review the complete Implementation Module of each scenario so that you are familiar with all aspects of the simulation scenario and its related resources In addition try to schedule some time with colleagues or a small group of students to do a practice run of the scenario before implemen tation with a large group of students Familiariza tion with the essential elements of each scenario will assist in the successful implementation of clinical simulation throughout the curriculum PREPARATION Y SCENARIO Y Preparing Yourself PREPARATION SCENARIO DEBRIEFING v RESOURCES Performance Objectives 4 PREVIOUS Screen 02 of 19 NEXT The student will 1 Provide individualized patient centered care by _ Conducting a focused assessment e Utilizing therapeutic communication techniques e Maintaining patient s dignity and privacy Developing an individualized p
138. tion or grading Interdisciplinary Communication SBAR situation background assessment and recommendation communication should be expected in all verbal reports during simulation The SBAR post simulation Interdisciplinary Communication activity gives students the opportunity to practice SBAR in a written format In this activity students are instructed to provide an SBAR change of shift report for the nurse assuming care for the simulated patient after the scenario is over The SBAR report can be submitted electronically to the facilitator for evaluation or grading Copyright 2011 by Elsevier Inc All rights reserved AE es 48 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS Post simulation Exercises activities extend the simulation experience beyond the lab promoting further critical thinking and clinical judgment related to events encountered during the scenario As with the pre simulation exercises answers are provided but because the exercises are short answer they are not self grading Once completed the student can submit the answers electronically to the facilitator for grading The Post simulation Quiz focuses on key scenario events and can assist the facilitator in identifying stu dents areas of understanding and areas needing additional review and practice The quiz is self grading and provides immediate feedback to students with rationales and page references to their nursing textbook ACTIVATING AN
139. ts to suspend disbelief and immerse themselves in the experience Students should interact with simulated patients as they would with live patients asking questions and responding to all participants They should be encouraged to talk and think out loud as they progress through the scenario Simulation provides a safe environment in which to practice clinical decision making skills without risking the health of real patients The clinical simulation environment provides opportunities to practice not only skills related to the nursing process but also skills of communication delegation and patient and family education Following the completion of the clinical simulation scenario debriefing is conducted by the facilitator to provide students with the opportunity for self reflection and to give students immediate feedback regarding their actions during the scenario The debriefing phase is integral to the learning process this structured reflection process helps students find relevance and meaning in the simulation experience Clinical simulation provides endless learning opportunities and can be used to reinforce understanding of difficult concepts and to allow students to practice skills and techniques related to communication teamwork and delegation The Simulation Learning System SLS is an educationally sound program that provides extensive step by step instruction for integrating simulation into the nursing curriculum and features a comprehen
140. uctions Cari DeLange is a 65 year old male with cellulitis of his left foot which is infected with MRSA The physician was just in and added an order for a warm moist compress to his left foot Verify the order in the EMR and perform the intervention Document your care in the EMR Current day amp time Wednesday 1600 Basic Nursing 7 Edition pp 1087 1088 1103 1104 Potter amp Perry Fundamentals of Nursing 7 Edition pp 1335 1338 Elkin Perry amp Potter Nursing Interventions 8 Clinical Skills 4 Edition pp 543 547 Drill Heat and Cold Therapy 1 Simple set up Manikin male with gauze dressing over left foot wound Patient identity band EMR for Cari DeLange Clock sign set to 1600 Clean gloves in a variety of sizes Hand sanitizer Paper towels Sink with running water Soap Sterile gloves Wastebasket Plastic bag Sterile basin Sterile gauze Sterile normal saline solution Facilitator instructions Position manikin lying supine in bed 9 Drill Heat and Cold Therapy 1 Skill Heat and cold therapy Variation Warm moist compresses open wound Purpose To provide students with the opportunity to apply a warm moist compress to a patient s foot Student outcomes 1 Verifies provider order in the EMR identifies patient using 2 identifiers Introduces self and explains procedure Places waterproof pad under affected body part Prepares compress
141. uld provide the majority of the discussion 3 Resp onsive nquir y Phase 1 Student Reaction 4 Integr ation Simulation experiences can be very emotional The reaction phase allows the students to vent their feelings so that further discussion and 5 Clo sure learning can occur Examples of appropriate facilitator comments include The Student Reaction phase allows students to e Tell us about what you experienced during the simulation vent their teelines immediately after the scenario Presse EE EE During this phase the facilitator invites students Phase 2 Student Reflection to share initial thoughts about the case Students pocas and orina sehe tan dung ile kun ODONIS caus m ni may experience intense emotional responses A especially if the patient suffered a negative out come Examples of appropriate facilitator comments include e Describe your thought process as you made decisions about e What patient response or assessment led you to ghe e Did the patient respond the way you thought he she would During the Student Reflection phase students are encour aged tor eflect on their decision mak Facilitators can use the Performance Checklist to identify and guide areas for inquiry ing process and on interventions conducted dur Examples of appropriate facilitator comments include ing the scenario During this phase all partici I noticed What did you think about that pants should be encour
142. uoneN 01 02 P el M eoueuuoJied JENPIAIDUI pue SS U AN H ulejs s 104 uBnouJui sJepi oJd pue sjuaned o wey JO YSL ZIWIUIN yyesy euundo jo 104 sen eA pue 5 Ajiuejuened pue esnjedxeo jesuo YIM eouepi oe 4 1999 peseg o2uopil 3 S l u dulo2 NASH P El M UONWINN JeJ0 uone no e eDesoq jueujeBeue N uled jeoiDoJooeuueud S IA Q SS SDOU A seidelay snoueAeJu JeJOo uSJed poojg pue DOO uoneJsiulupy UONBIIPpanN seujloojno suonoyv pajoadx3 SUOIn28J9 U S 99J3 epig suoneoipurleJjuOo2 S 299JI 9SSJOADV 0 Dau jou SI 3nq sepnjoui ISO pajejay seideJay e ajualed pue suonesipau Jo uoneJjsiuiupe BY o eJeo Bulpino1d S31AVYI3HL IWYHSLNAYVd ANY 1V2190702V NGYHd AYOOALVIANS eX319N suoneJ aye uyeeu Bulbeueu pue enuajod ysi juaned Hulonpes Hojuioo pue ales BulplAoid Aq ss ull M pue yyesy eorsAud sejououd esunu oul 11H91 NI 12190 10ISAHd AMOO3IVO eX319N SAIdVYSAHL 1V4M41N434Vd ANV 1V29I90109VNWHVHd ALlSHO3LINI TVDISOITOISAHd 79 p3uoo ouqns uonenj eA 3 J9A19SqQO Copyright O 2011 by Elsevier Inc All rights reserved 63 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS uonipuoo sau ned e ui seDueuo o asuodsa pue uoniuDooaJ 9 JEON uone ndod juened ul jueJeuur su jaje
143. uring or after the debriefing session in order to facilitate student reflection and maximize learning If the facilitator chooses each performance behavior can be assigned a point value and the checklist can easily be converted into a grading tool For example the student may earn a 2 if the performance exceeds expectations and a 1 if it meets expectations The decision to use these scenarios as a grading tool or for competency testing should be made before the start of the scenario and identified in the course syllabus Students should be informed of this during the clinical simulation orientation period SCENARIO v DEBRIEFING v RESOURCES v Preparing Your Students Preparing Your Students 4 PREVIOUS Screen 05 of 19 NEXT b An important part of the student simulation expe rience is preparation You can help your students me maximize their time in simulation by assigning EA AA i Provide student access to the Pre simulation pre simulation and post simulation homework Quiz and additional Student Resources as x using the available scenario specific resources e Provide student access to the scenario related Skills Drills or select your own from the Skills m The Resources section of the Implementation OO R The 515 Implementation Guide provides Module lists all of the pre and post simulation detailed instructions on enabling and R Isabiing e student resources learning resources that can be assigned I
144. ursing students play this role as it is beyond their scope of practice SBAR Communication During communication with the physician or health care provider students should be instructed to provide clear and concise communication regarding the patient condition in the format of situation background assessment and recommendation SBAR SBAR provides a framework for effectively communicating relevant patient information in an effort to minimize errors in the health care setting and optimize patient safety When reporting about the situation students should identify themselves Copyright O 2011 by Elsevier Inc All rights reserved cuEE A SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS 25 and the environment and provide clear information regarding the events occurring at the present time Background information includes the events leading up to the current situation including the patient s diagnosis medications brief summary of hospitalization recent vital signs and other relevant clinical information Assessment includes the student s analysis of the patient situation Finally students should give their recommendation or what they feel can be done to improve the patient situation for example requesting an order for diagnostic tests or medications or demanding the patient be seen immediately The following is an e
145. utinely reviewed and will help us continue to develop timely and relevant scenarios e The Provide Feedback link lets you send comments and questions directly to the SLS development team The Acknowledgements link contains a list of the fantastic nursing and health care professionals who have worked to develop the SLS e The Course Updates link contains updates made to the SLS The SLS provides you with comprehensive resources to support your simulation mission all of which are fully integrated with your adopted textbook Each simulation scenario has been uniquely tagged to page specific content within the textbook As you work through the exercises assignments and scenarios you will find text references providing rationales and related content Copyright O 2011 by Elsevier Inc All rights reserved quqpmm MA S 4 SLS IMPLEMENTATION GUIDE FOR NURSING FUNDAMENTALS In the next section we will walk through the SLS product step by step Please take the time to understand each step so that when you begin to run a scenario you will have a complete grasp of the resources avail able to you Let s get started Simulation Learning System Recommended Protocol The following is the recommended protocol for facilitating a simulation scenario from start to finish using the SL
146. xample of nurse to provider communication in the SBAR format Situation Hello Dr Rebecca I am Sarah Matthews a nurse on unit 6G at Local Hospital I m caring for Ms Ann Howard who is experiencing a sudden onset of shortness of breath Background Ms Howard 1s a 67 year old female who was admitted from the emergency department for an exacerbation of her COPD last evening She also has a history of hypertension Following lab tests and a chest x ray she was placed on 2 liters of oxygen via nasal cannula and IV steroids An antibiotic was started for treatment of possible bronchitis Assessment During my 7 AM assessment I noted the following vital signs temperature of 99 3 F pulse of 114 bpm shallow respirations of 26 and blood pressure of 148 86 Her pulse oximeter is reading 92 She is moderately anxious and speaking in 2 to 3 word sentences Bilateral breath sounds reveal wheezes throughout all lung fields I have increased her oxygen flow rate to 4 liters via nasal cannula and am contin uously monitoring her oxygen saturation Recommendation Since there is no order for bronchodilators on her chart I am requesting an order to administer a fast acting bronchodilator STAT I will notify you with an update on her condition following the respiratory treatment Participant Role Badges S Participant Role Badges Role badges are provided for each scenario for participants including primary nurse secondary nurse
147. xperience 4 PREVIOUS Screen 09 of 19 NEXT Physiologic State T 101 6 F 38 7 C e Maurice states I m sorry about the mess deep BP 142 80 breath I m so embarrassed deep breath feel P 108 so weak deep breath RR 30 O Sat 86 room air Situation Transition Until oxygen is titrated to maintain an oxygen saturation level above 92 at an oxygen flow rate of 4 L min and head of bed is elevated Maurice Arviso continues to be short of breath Recommended time to advance to Phase III 10 15 minutes Expected Student Performance 1 Prioritizes respiratory interventions over personal hygiene interventions 2 Raises head of bed and repositions patient 3 Administers oxygen via nasal cannula to maintain oxygen saturation level above 92 Explains need to decrease oxygen demands e g minimal talking rest Changes bed linen and cleans patient Maintains dignity and privacy Cleans urine spill on floor w EAR 4 PREVIOUS NEXT gt and blood product administration depending on the specific scenario As in Phase I the Physiologic State Situation Transition Recommended Time to Advance and Expected Student Performance are provided Copyright O 2011 by Elsevier Inc All rights reserved coupuM 32 S
148. xygen is administered but the head of bed is NOT elevated T 101 6 F 38 7 C BP 134 78 P 105 RR 28 O Sat 88 2 L min via nasal cannula e Maurice states I feel a little better with the oxygen on deep breath but it s still so hard to breathe O Sat 90 3 L min via nasal cannula e Maurice states That oxygen is helping some deep breath but it s still so hard to breathe O Sat 91 4 L min via nasal cannula e Maurice says I feel better but I still can t really catch my breath deep breath Is there anything else you can do to help me breathe easier deep breath If oxygen is NOT administered but the head of bed is elevated T 101 6 F 38 7 C e Maurice states At least deep breath BP 148 86 Im not lying flat deep breath but I P 110 still can t breathe deep breath RR 32 O Sat 87 room air If oxygen is NOT administered and the head of bed is NOT elevated T 101 6 F 38 7 C BP 156 88 P 112 Maurice states Help deep breath breathing worse deep breath call doctor deep breath RR 34 O Sat 84 room air Situation Transition If oxygen is administered and the head of bed is elevated Maurice Arviso s oxygen saturation level will increase and his dyspnea will decrease in correlation with the oxygen flow rate Vital signs will return to baseline when the oxygen saturation level rises above 92 at an oxygen flow rate of 4 L min
149. y wish to include specific institutional policies and procedures that guide the process of data record ing management and storage 4 RESOURCES a SIMULATION LEARNING SYSTEM Oxygenation and Hygiene PREPARATION Student Resources Numerous scenario specific resources are avail able for student learning and evaluation before and after simulation The Student Resources screen summarizes these resources for each scenario For detailed instructions on activating these resources see the Using Student Faculty and Evolve Resources section of this guide page 46 SCENARIO d DEBRIEFING PREPARATION v Student Resources 3 Fe Em ur Ea RESOURCES SCENARIO Y DEBRIEFING Y RESOURCES Y 4 PREVIOUS Screen 18 of 19 NEXT The following learning resources are provided to students for Scenario 8 e Reading Assignment e Pre simulation Exercises e EMR e Documentation e Concept Mapping C e Journaling E e Interdisciplinary Communication e Multimedia Resources The Simulation Learning System allows you to make the following additional learning resources available to students at your discretion e Skills Drills e Pre simulation Quiz e Post simulation Exercises e Post simulation Quiz e RN to RN Patient Report Return to the scenario folder to access these resources The SLS Implementation Guide provides detailed instructions on enabling and disabling the student resources 4 PREVIO

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