Date accepted: - Quality and Safety Education for Nurses



Simulation Design Template

Date: 2/3/09 File Name: Mr. Burns Pain Simulation

Discipline: Nursing Student Level: Freshmen

Expected Simulation Run Time: 5-10min Guided Reflection Time: 15-20

Location: LRC Location for Reflection: LRC

|Admission Date: 2/1/09Today’s Date: 2/3/09 |Psychomotor Skills Required prior to simulation: |

|Brief Description of Patient: | |

|Name: Mr. Melvin Burns Gender: M Age: 63 Race: Caucasian |Students should have attended "communication lecture" as well as "comfort therapy|

|Weight: _70kg Height: _180_cm |lecture" in N111. |

|Religion: Protestant Major Support: Wife |Basic understanding of empathy and using therapeutic communication skills. |

|Phone: |Basic understanding of non-pharmocologic comfort measures for patients |

| |experiencing pain. |

|Allergies: NKA | |

|Immunizations: Flu Vaccine 11/08 |Cognitive Activities Required prior to Simulation: i.e. independent reading (R), |

|Attending Physician/Team: Dr. Vivian |video review (V), computer simulations (CS), lecture (L) |

| |Lecture: Therapeutic Communication |

|Past Medical History: 3 days post R knee replacement. Physical therapy daily |Reading: " " |

| |Lecture: Comfort/Pain Therapy |

| |Reading: " " |

|History of Present illness: Surgery on 2/1/09 | |

| |Video: Introductory Video to Mr. Burns Simulation, 5 minutes in length. |

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|Social History: Lives with wife of 30 years | |

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|Primary Medical Diagnosis: | |

|Surgeries/Procedures & Dates: Total R knee 2/1/09 | |

Simulation Learning Objectives:

1. The student will be able to assess Mr. Burns' level of comfort using the nursing process.

2. The student will be able to provide nursing interventions to address the need for increased level of comfort.

3. The Student will be able to formulate a nursing diagnosis and plan of care for Mr. Burns as a post-reflection activity.

|Quality and Safety Education For Nurses |'QSEN Coordinated' |

|(Chose applicable QSEN Competencies) |Student Learning Objectives for Simulation Experience |

| |(KSA's) |

|√ Patient-centered Care: |Knowledge |

| |1. Integrate understanding of multiple dimensions of patient-centered care: Patient / family / community preferences, |

|Recognize the patient or designee as the |values; Coordination and integration of care; Information, communication, and education; Physical comfort and emotional |

|source of control and full partner in |support; Involvement of family and / or friends; Transition and continuity |

|providing compassionate and coordinated care|2. Examine how the safety, quality, and cost-effectiveness of healthcare can be improved through the active involvement|

|based on respect for patient's preferences, |of patients and families |

|values, and needs. |3. Describe strategies to empower patients and families in all aspects of the health care process |

| |4. Discuss principles of effective communication |

| |5. Examine nursing roles in assuring coordination, integration, and continuity of care |

| |Skills |

| |1. Provide patient centered care with sensitivity and respect |

| |2. Assess presence and levels of pain as well as physical and emotional comfort |

| |3. Engage patients and surrogates in active partnerships that promote health, safety and well-being and self-care |

| |management |

| |4. Communicate care provided and needed at each transition in care |

| |Attitude |

| |1. Respect and encourage individual expression of patient values, preferences and expressed needs |

| |2. Appreciate the role of the nurse in relief of all types and sources of pain and suffering |

| |3. Value active partnerships with patients or designated surrogates in planning, implementation, and evaluation of care|

| |4. Value continuous improvement of own communication and conflict resolution skills |

|√ Teamwork and |Knowledge |

|Collaboration: |1. Recognize contributions of individuals and groups to help patients / family achieve health goals |

| |2. Discuss effective strategies for communicating and resolving conflict |

|Function effectively within nursing and |3. Describe examples how team functioning impacts safety and quality of care |

|inter-professional teams, fostering open |4. Identify barriers and facilitators of effective team functioning |

|communication, mutual respect, and shared |5. Examine strategies for improving systems to support team functioning |

|decision-making to achieve patient care. |Skills |

| |1. Act with integrity, consistency, and respect for differing views |

| |2. Assume the role of team member or team leader based on the situation |

| |3. Integrate the contributions of others who play a role in helping patient / family achieve goals |

| |4. Solicit input from other team members to improve individual, as well as team performance |

| |5. Follow communication practices that minimize risks associated with handoffs among providers and across transitions |

| |in care |

| |Attitude |

| |1. Respect the unique attributes that members bring to a team |

| |2. Appreciate importance of intra- and inter-professional collaboration |

| |3. Value teamwork and the different styles of communication used by patients, families and health care providers |

| |4. Appreciate the risks associated with patient information handoffs |

Fidelity (choose all that apply to this simulation)

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| |Student Information Needed Prior to Scenario: |

| |Has been oriented to simulator |

| |Understands guidelines /expectations for scenario |

| |Has accomplished all pre-simulation requirements |

| |All participants understand their assigned roles |

| |Has been given time frame expectations |

| | |

| |Report students will receive before simulation: Show introductory video, assign |

| |roles, and distribute cue cards/lanyards. |

| |Time: Approximately 5-10 minutes |

References, Evidence-Based Practice Guidelines, Protocols, or Algorithms used for this scenario: (site source, author, year, and page)

NCLEX Test Plan Category (bolded areas are included in the simulation)

Safe, Effective Care Environment

Management of Care

o Advanced Directives Clients Rights Collaboration

o Advocacy Confidentiality Delegation

o Case Management Establishing Priorities Informed Consent

o Legal rights and responsibilities Performance Improvement Referrals

o Staff Education Resource management Supervision

Safety and Infection Control

o Accident Prevention Disaster Planning Error Prevention

o Emergency Response Plan Handling Hazardous and Infectious Materials

o Injury Prevention Medical and Surgical Asepsis Security Plan

o Reporting of Incident Event Safe Use of Equipment Restraints

o Standard / Transmission Based Precautions

Health Promotion and Maintenance

o Aging Process Ante/Intra/Postpartum and Newborn Care

o Developmental Stages Disease Prevention Family Planning

o Expected Body Image Changes Family Systems Growth and Develop

o Health and Wellness Health Promotion Health Screening

o High Risk Behaviors Human Sexuality Immunizations

o Lifestyle choices Self Care Physical Assessment

Psychosocial Integrity

o Abuse / Neglect Behavioral Interventions Crisis Intervention

o Chemical Dependency Coping Mechanisms Cultural Diversity

o End of Life Family Dynamics Grief and Loss

o Mental Health Concepts Psychopathology Stress Management

o Religious and Spiritual Influences Sensory / Perceptual Alterations Support Systems

o Situational Role Changes Therapeutic Communications

o Therapeutic Environment Unexpected Body Image Changes

Physiologic Integrity

Basic Care and Comfort

o Alternative and Complimentary Therapies Assistive Devices

o Elimination Mobility / Immobility Rest and Sleep

o Non-Pharmacologic Comfort Palliative / Comfort Care Personal Hygiene

o Nutrition and Oral Hydration

Pharmacological and Parenteral Therapies

o Adverse Effects/Contraindications and Side Effects Dosage Calculation

o Blood and Blood Products Central Venous Access Device Intravenous Therapy

o Expected Outcomes / Effects Medication Administration Parenteral Fluids

o Pharmacologic Interactions Pharmacologic Pain Management TPN

Reduction of Risk Potential

o Diagnostic Tests Laboratory Values Vital Signs

o Monitoring Conscious Sedation Potential for Alteration in Body Systems

o Potential for Complications from Surgical Procedures and Health Alterations

o System Specific Assessment Therapeutic Procedures

Physiologic Adaptation

o Alteration in Body Systems Fluid and Electrolyte Imbalances Hemodynamics

o Illness Management Infectious Diseases Medical Emergencies

o Unexpected Response to Therapies Radiation Therapy Pathophysiology

Scenario Progression Outline

|Timing |Manikin Actions |Expected Interventions |May use the following Cues: |

|(approximate) | | | |

| 2 minutes | | |Role member providing cue: TA |

| |Poor position in bed, wound bandaged, moaning |Student nurses should begin to assess Mr. Burns | |

| |and groaning. Asking "Can I have something for |pain. Have him rate his pain on a scale of 1-10, |Cue: Is there a way we can assess |

| |this pain?" |identify the location and quality of pain. Remind |his pain? |

| | |Mr. Burns he is not due for his Tylenol #3 yet. | |

| | |Should take his vital signs | |

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| | | |Role member providing cue: TA |

| | |Students should assess the site, offer to elevate | |

|2 minutes |Wife interacts with Mr. Burns and begins |the R knee, change his position, ask about what |Cue: Should we assess the site? |

| |demanding the student nurses do something for |activities may help to keep his mind off the pain |Are there any activities that would |

| |his pain. |(music, TV, playing cards). |provide distraction? |

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| | | |Role member providing cue: TA |

| |Wife continues to be demanding and very |The student nurses should look to alter his | |

| |emotional...Mr. Burns continues to complain of |environment: | |

|2 minutes |pain. |dim the lights, provide privacy, and some quiet |Cue: Should we ask Mrs. Burns to |

| | |time. Perhaps ask Mrs. Burns to "take a break" and|leave? |

| | |"leave Mr. Burns rest. | |

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Debriefing / Guided Reflection Questions Utilizing QSEN Competencies:

(Adopted from the NLN Debriefing/Guided Reflection QSEN Overview for Laerdal Simulations, Volume II))

General opening questions frequently used to start the debriefing session:

Can someone give me a summary of the experience?

How did the experience feel?

What problems were identified?

What went well?

Patient-Centered Care:

Definition: recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs.

Describe how you involved family members in the patient care being provided.

How did the patient describe his/her symptoms?

What have you learned from this patient?

Describe your assessment of this patient’s physical pain. Was this thorough? Did you miss anything?

Did you assess emotional pain/suffering? Why or why not?

Was the patient’s expression of pain impacted by culture/ethnicity?

What intervention did you apply for the patient’s pain? Was it effective? How do you know this?

How did you feel that you managed to “share decision making” with your patient?

Describe your communication with your patient. Appropriate boundaries? Therapeutic? Mutual respect?

Describe the level of “caring” that was demonstrated in your communication with your patient.

How did you handle the conflict between patient’s rights and organizational responsibility for patient care?

Discuss the level of empowerment you felt your patient exhibited. What did you do to facilitate empowerment?

How was your patient informed?

How was consent provided for procedures?

Did you feel that the patient received coordinated, continuous care during a transition of care? Why or why not?

Teamwork and Collaboration:

Definition: function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

Describe your personal strengths and limitations as a team member.

Did you identify a leader in the clinical simulation experience?

Can you describe who the leader was?

Why do you think this person became a leader?

Describe the scope of practice of all participants in the scenario.

Did you feel that everyone functioned within the scope of practice? Why or why not?

Describe who you called for help.

What lead up to this request for help?

Describe your collaborative efforts.

Describe your utilization of resources available.

Were roles clear?

Was communication closed loop and clear? How do you know this?

Were all the contributions acknowledged and respected?

Was there a conflict? Was the conflict resolved? How?

Describe “systems” that support effective teamwork and ineffective teamwork.

Debriefing/Guided Reflection Overview

General wrap-up questions frequently used to close the debriefing session:

What will you take away from this experience?

What would you do differently next time?

What discoveries have you made?

What did you learn about yourself?

Complexity – Simple to Complex

Suggestions for changing the complexity of this scenario to adapt to different levels of learners:

Have participants repeat the simulation, selecting different roles the second time.

Have Mr. Burns develop shortness of breath or chest pain for a sophomore level/med/surg experience.

Include a heart monitor and have him develop Atrial Fibrillation.

Evaluation Log & Checklist of Competencies in Simulation Experience:

Simulation Topic:

Date of Experience:

Level of Student:

# of Students Participating:

Faculty Person Coordinating:

LRC Person Coordinating:

TAs Participating:

QSEN Competencies ID Attained Appropriateness/Barriers/Areas for Improvement

○ Patient Centered Care ○Y ○ N Provide Feedback:

○ Teamwork /Collaboration ○Y ○ N Provide Feedback:

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