Date accepted:



SUMMARY FOR SIMULATION CENTER TECHNICIAN

|Expected Simulation Run Time: _15__ min Debriefing Time: _25-45__ min |

|Age: 6 yo |

|Weight: |

|HPI: Patient was found at the bottom of the swimming pool unsure how long he was immersed. CPR done at the scene. Brought to CNMC ED in full code. |

|Resuscitated and admitted to the PICU, 3 days ago. Remains un-responsive. |

EQUIPMENT

|Setting/Environment |Medications and Fluids |

|ED |IV fluids @       |

|Inpatient floor |Oral meds: |

|PICU |XIV meds:       vasopressin, epi, dopa |

|NICU |IM/ SC meds: |

|OR/ PACU | |

|Outpatient clinic |Diagnostics Available |

|Atrium/ lobby |Labs |

|Other:       |x-rays (images) |

| |12 lead EKG |

|Simulator Manikin/s Needed: |Other:       |

|Premie HAL | |

|Sim Baby |Documentation |

|Sim Junior, intubated and attached to a ventilator |Sign Out |

|Sim Man |H&P |

|Megacode Kid (Cody Blue) |Orders |

|Other:       |VS flow sheet |

| |I/O flow sheet |

|Props: |Other: Code Sheet |

| |DNR |

|Equipment attached to manikin: | |

|IV fluids | |

|IV medication- vasopressin, epi, dopa |Recommended Mode for Simulation (i.e. manual, programmed, etc.) |

|Oxygen. Route: |      |

|Monitor |Keepsake box |

|ID band |WRTC |

|Tube feeding | |

|Central line | |

|Other: ventilator | |

| | |

|Equipment available in room | |

|Fluids | |

|IV start kit | |

|IV tubing | |

|Monitor available | |

|Large syringes | |

|Oxygen delivery device (nasal canula, face mask) | |

|ambu bag (with bag of masks attached. Do not attach approriate sized mask. | |

|Do not attach to oxygen source.) | |

|suction (yankauer available but tubing not connected) | |

|code cart | |

|defibrillator/ pacer | |

|nasopharyngeal airway/ trumpet | |

|bulb suction | |

|xother: x postmortum kit | |

|LEARNING OBJECTIVES |

|After this simulation, the participants will be able to: |

|Demonstrate therapeutic support and compassionate end-of-life communication |

|Practice inter-disciplinary collaboration prior to, during and following brain-death evaluation |

|Demonstrate patient and family-centered approach to care |

|Pre-Requisite Knowledge |

| Knowledge of brain–death criteria |

|Knowledge of End of Life Family–Centered Care |

|Knowledge of cultural sensitivity |

|Participants |

|Primary Nurse: |

|Buddy nurse: |

|Charge Nurse |

|Attending: |

|Fellow: |

|Social worker: |

|Chaplin: |

|Parents: |

|PSA/PCT: |

|Observers: |

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|References, Evidence-Based Pra |

|ctice Guidelines, Protocols, or Algorithms Used For This Scenario: |

Beckstrand, R., Rawie, N., Callister, L., & Mandleco, B. (2010). Pediatric Nurses’ Perceptions of

Obstacles and Supportive Behaviors in End- of –Life Care. American Journal Of Critical Care,

19(6), 543-552.doi:10.4037/ajcc2009497

Dickens, D. (2009). Building competence in pediatric end-of life care. Journal Of Palliative Medicine, 12(7), 617-

622. doi:10.1089/jpm.2009.0032

Jeffries, P. (2005). A framework for designing, implementing, and evaluating: simulations used as teaching

strategies in nursing. Nursing Education Perspectives, 26(2), 96-103.

OUTLINE OF SCENARIO PROGRESSION

|Segment/ timing: |Manikin Actions |Expected Participant Actions |Cues: |

|Initial Assessment/Evaluation | |Attending: conducts brain-death |Evaluation/Assessment= |

| |VS: Monitor |evaluation-confirms | |

| |HR: 100 |findings/prognosis |Brain Death Criteria |

| |Resp. (no resp effort) Vent rate 20 |-assure parents of comfort | |

| |BP- 100/65 |measures/pain management | |

| |Sats- 96% |-info-regarding withdrawal of care | |

| | |-information given regarding organ |Discuss family meeting |

| |Neuro-Unresponsive |donation-contact WOTC | |

| | |-discussion re: autopsy/death | |

| | |certificate | |

| | | | |

|Labs |ABG ph 7.35 CO2: 35 | | |

| |(normalized ph; starting co2 goal btn |Fellow: check in to assess emotional |Continue to check in with parents and |

| |35-45mmHg) |state and status of decision making |staff |

| | |process | |

| |Epi/Dopamine/Vasopressin | | |

|GTTS | | | |

| |CNS depressant meds must be absent as | | |

| |well as neuromuscular blockades) | | |

| | |Attending/Fellow | Deliver news of brain death/discussion|

|Delivery of news to parents | | |of donation of (WRTC)organs/withdrawal |

| | |Primary Nurse: identify any language |of care and it’s process |

| | |barriers/contact lang. services-also | |

| | |identification od added support of |Obtain ABG and Labs-confirmation |

| | |significant other--offering of |Identify religious/spiritual |

| | |keepsakes-offering participation in |belief-offer Chaplain |

| | |postmortem care-be mindful of | |

| | |religious aspects to pm-care | |

| | | | |

| | | | |

|Allowance of Time Alone w/patient | |Charge Nurse: provides relief for |Relieve primary nurse |

| | |primary nurse/access additional | |

| | |resources | |

|Withdrawal of Care | |Parent/s: identify religious beliefs-|Attend family meeting-pose questions |

| | |-allow time for grieving | |

| | |-participation in postmortem care | |

| | |Social Worker: provide list of |Support parents-offer contacting of |

| | |resources-grieving support groups |family members-visit |

|Postmortem Care | |Chaplain: provide spiritual | |

| | |support/baptism- or depend on | |

| | |religious beliefs | |

| | |PSA/PCT: assists with accessing |Keepsake Box |

| | |supplies as needed –“go for” if |Postmortem Kit |

| | |needed | |

DEBRIEFING

Briefly orient participants to debriefing:

1. Remind of safe learning environment and confidentiality.

2. Communicate expectations to be active and vocal in evaluation of their own performance and that of the team.

3. Remind that your role is of facilitator/ guidance, not lecturer.

Potential initial questions (if time permits):

• What were some of your successes? What would you do differently if given the opportunity?

• How did you perform as a team?

Suggested targeted debriefing questions:

1. How did that feel?

Conclusion:

• Highlight take home points based upon learning objectives.

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