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Welcome

Virtual Simulation

Carl Shapiro

Nursing Care Plan\

Evaluation

REview

BREAK!

1

Medical Surgical Nursing II

C Shapiro

VIRTUAL Simulation

Student Expectations

Medical Surgical Nursing II

V WATKINS

VIRTUAL Simulation

WELCOME

The Nursing Student handbook can be found on blackboard in your LAB shell under Course Essentials

Your university student handbook can be found by accessing this website:

https://concordia.csp.edu/cspstudent/

Student handbook!

We believe that everyone participating at activities at CSP is intelligent, capable, cares about doing their best, and wants to improve. AND THIS IS HOW WE ENSURE THIS WILL HAPPEN...

Netiquette

Dress Code

  • Students are required to wear their school uniform per policy.
  • Only approved solid color long sleeves shirts allowed.
  • Hair must be up.
  • Student badge must be worn.

Dress code

You may be asked to leave if

you are unable to follow

the dress code.

Environment

Pick somewhere quiet

Avoid guest appearances

Make the most of your break times to avoid distractions during clinical

Remain on mute when not sharing

Work Environment

Use a virtual background if there are distractions in your space

Phone use

Phones should

  • be on silent
  • put away
  • only used for emergency

Phone use

Please do not use your phone during clinical.

You are not sneaky. We can all tell when you are on it.

It is distracting!

OUR CODE OF CONDUCT

This is virtual simulation-VSim might be a deifferent format than traditional simulation i-person at your lab site. However, it IS simualtion. We will follow thesame Code of Conduct and Fiction Contract that we use in traditional simualtion.

GOAL

The goal of simulation in the nursing program is to provide nursing students with opportunities to practice their clinical and decision-making skills and increase individual confidence and clinical judgement in a safe learning environment.

OUR CODE OF CONDUCT

PSYCHOLOGOCIALLY SAFE: This is a no judgement zone. there will be no critizing or judging.

MISTAKES/LEARNING OPPORTUNITIES We learn from our mistakes. Understanding thought processes that led to a mistake allow is a;; to learn fomr them and decreases the chance of it happening again. Hence, a learning opportunity! None want mistaked to repeat.

CONFIDENTIALITY - What hapeend in Virtual Simulation,stays iin virtual simulation. this will preserve learning and maitain the integrity of the simulation/learning for other groups. Also, this maintains confidentiality within our own group.

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EXPECTATIONS- Try to suspend disbelief and immerse yourself in the scenario. Be an active participant in whatever role you are in at the tme. There is no lurking in the cyberspace background.

RESPECT- Be respectful of your peers and your faculty. We live in an ethnically rich and deverse, multi-cultural world. Please do not use language thatis, or could be misconstrued to be, offensive toward others. There will be zero tolerance for racist, sexist, hetrosexist comments or jokes, as well as deragatory or sarcastic comments and jokes directed at religious beliefs, diaabilities and age.

PERSPECTIVE - Similar to traditional simulation, instead of being critical of others actions, be inquisitive and attemp to understand. Be supportive and provide your perspective and observations ina thoughtful, honest, articulate, and constructive manner. We are all professionals and need to behave that way all the time.

Final Though: No matter where you ar ein your learning, simulationis always a great way to expand skills and knowledge.

Final thought:

What happens in VSim, stays in VSim.

Prework & Postwork are NOT group work.

There is a ZERO tolerance for late work.

Prework is to be submitted 48 hours before your clinical. If your prework is submitted late, you receive a zero and will not be able to participate in your VSim. No extension granted. An academic support form will be filled out for the incident and forwarded to the Coure Lead.

Post work is to be submitted within 72 hours after your clinical. If you submit your post work late (with no prior request and approval for extension), 10% will be deducted from your grade for every day it is late and on day 4 you will recieve a zero.

Grading

All assigned tasks must be submitted prior to the end

of the semester (even if you will receive a zero on the work). Not doing so may result in failure in the course. NO submissions are accepted week 16.

Midterm and Final Evaluations must be submitted on time. If not turned in within 4 days of due date, the evaluation will recieve a fail. This will put you at risk for failure in the course.

Be sure to review all of your instructor feedback attached to

your grade in BB. This is how you make your work better.

Before you email your instructor, be sure you have used your resources and worked to find your answer!

Emailing your instructor

Emailing your instructor

It is best if you can email your instructor directly from Blackboard.

Assure you are emailing the correct instructor?

Be sure to include your section number.

Are you emailing the correct instructor?

Okay, I've already used my resources and I can't find what I am looking for.

Reach out early. Sometime it takes time to hear back. So, review your assignment early and don't wait to ask questions.

If you require an extension on your POSTWORK assignment these accommodations must be made with your instructor via email prior to the due date.

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Title

RESOURCES

Blackboard Course Information

Reread that BB course informatation you just skimmed

Other classmates

What are my resources?

NURSING CARE

PLAN

2

OVERVIEW

OVERVIEW

The purpose of a nursing care plan is to use the nursing process to identify the problems of a client and find solutions to the problems. One important thing to do when you are first talking to your client is to let them know what the plan of care for the day is going to be. This will be an abbreviated version of your care plan. Let them know what you want to see them accomplish for the day and how together you can accomplish it. Remember that even the best care plan is useless unless the client also believes in the same goals.

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STUDENT

EVALUATIONS

Step 1

1

Complete the Mid-term student comments and ratings by the end of Simulation#2 by directly accessing the working Google doc. via the link in blackboard. Students are responsible for including specific examples of their performance for each of the 9 required clinical competencies as their self-evaluation. Students must maintain the formatting of this working document as this will be used for all subsequent student and faculty evaluations. Submit your mid-term self-eval to BB via the link above, labeled with your last name, first initial, and midterm eval PLEASE SUBMIT IN WORD FORMAT.

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EXAMPLE

Step 3

3

Complete the Final student comments and ratings by the end of Week 5. You must retrieve the completed mid-term eval containing both your self-evaluation and instructor evaluation and add to this same document your final self-evaluation. Students are responsible for including specific examples of their performance for each of the 9 required clinical competencies as their final self-evaluation. Students must maintain the formatting of this working document as this will be used for all subsequent student and faculty evaluation. Re-submit your final self-eval to BB via the link above, labeled with your last name, first initial, and final eval'.

EXAMPLE

STEP 2

2

Your instructor(s) will review your mid-term student self-evaluation and add their mid-term ratings, comments, and signature(s) by the end of Week 8 then re-attach via BB grade book for you to review. Students are responsible for accessing the instructor evaluation, reviewing specific feedback, and signing the bottom of the evaluation tool.

Any student who is not meeting a minimum passing rating of 2.5 on all required competencies should arrange for a meeting to review the evaluation and develop an academic support plan with their clinical instructor(s) and course lead faculty.

Example

STEP 4

4

Your instructor(s) will review your final student self-evaluation and add their final ratings, summary comments including recommendations for further development/improvement, and signature(s) by the end of Week 15. Students are responsible for accessing the final evaluation, reviewing specific feedback, reaching out to the instructor with any questions or clarifications, and signing the bottom of the final evaluation tool. For the Final Evaluation, students must achieve the minimal expected level of performance (2.5 rating) for each competency in order to pass the course and progress in the program.

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EXAMPLE

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Review Documentation

Expectations

Documentation

Documenation

Whiteboard activity

Assessment expectations

Event note

Include :

  • s/s of event
  • your action
  • provider notification
  • orders implemented
  • response to treatment.

Hit the highlights

Scenario: Carl Shapiro

Location: Telemetry Unit

Carl Shapiro is a 54-year-old male who travels frequently. He was seen in the Emergency Department at 1:30 p.m. for complaints of chest pain, diaphoresis, and shortness of breath. He was treated in the Emergency Department with aspirin and two doses of sublingual nitroglycerin. Chest pain improved with nitroglycerin administration. IV infusion of normal saline was started in the Emergency Department and is running at 25 mL/hour. Ordered lab values are pending.. Provider wants to be called as soon as the labs are available. Patient is receiving oxygen at 4 L/min with Sp02 values at 97%. Chest pain was last rated as a “0” following second nitroglycerin dose and nitroglycerine patch 0.4 mg. He has been admitted to the Telemetry Unit.

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30 minutes to complete

Prebrief

Learning Objectives:

Learning objectives

Scenario Specific:

• Implements a focused cardiovascular assessment of a patient with acute coronary syndrome

• Recognizes cardiac arrest/ventricular fibrillation

• Implements basic life support algorithm, including use of automatic external defibrillator (AED)

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General:

• Selects appropriate patient assessments

• Evaluates patient assessment data

• Identifies the primary patient care problems/nursing diagnoses

• Prioritizes patient care

• Implements patient care that meets quality, safety, and evidence-based standards

• Utilizes team members as appropriate

• Provides patient education

Medications

Morphine

Provider orders

Medication

• Telemetry Unit orders:

• IV normal saline at 25 mL/hour

• Oxygen to maintain SpO2 greater than 92%

• Continuous ECG and SpO2 monitoring

• Activity: bed rest with bathroom privileges

• Diet: healthy heart diet

• Meds

o Morphine 2 mg IV push PRN chest pain every 10 minutes × 3; every 2 hours and notify care provider if chest pain returns

• Chest x-ray, basic metabolic panel, complete blood count, troponin and CK-MB every 8 hours × 3 (first set obtained in Emergency Department); notify provider with lab results as soon as available

Simulation Enviroment

Simulation Reminders

Safe Learning Enviroment

  • Enter sim world as authentically as possible

Psychologically safe

  • No judgement zone

Mistakes are typical

  • It’s how you learn
  • Ask the Charge Nurse

Confidentiality

  • What goes on in Sim world stays in the Sim world (content and actions)

Expectations

  • What are you expected to learn/ accomplish? (put it in chat box)

What clarification do you need of simulation ?

Reminder: Step into the sim world with authenicity of work world

Prework/Shift preparation

Using the Think in action tool

Divide into groups of 3 and review your handover report and information within the EMR

1. Complete first four columns: (Recognize Cues, Analysis, Priotize Hypothesis)

2. Create three interventions you may anticipate to perform

3. List the tasks that the orders direct you to complete as you care for the patient.

4. Now prioritize both lists

Before you start

During your vSim

Open EHRTutor Complete the documentation requirements

Remember charting should always be in your own words!

60-90 minutes to complete

Work in groups of three

We will rotate who will go first with each new simulation

Think out loud

Support your Peer

this is a Safe Space for Learning

**Remember: to call instructor for medication Administration or Procedure **

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vSim

Clinical WORKSHEET

Documentation standards

  • Vital signs: 1 set of vital signs (initial)
  • Assessment: 1 (full initial)
  • IV line (location, site, flushed
  • Event note

Docu- mentation

PRE-QUIZ

PRE_QUIZ

Take the pre-quiz and

Note the items you miss.

Jot them down for your reference and learning.

These nuggets will guide your study and add to your knowledge and professional practice.

Work independently over the next 10-15 minutes to complete your simulation post quiz.

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Take a 5 min break!

Post-Quiz!

120 minutes to complete

DEBRIEF And DISCUSSION

6

Debrief

Debrief Topics

Initial Reactions

How did the scenario make you feel?

What was your firsts reaction when you notices his signs and symptoms?

Discuss safety aspects during defibrillation.

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Electricity will take the path of least resistance, so if there is water on the chest then the shock will travel through the water instead of the heart muscle.

No one should touch the patient during delivery of the electrical shock by an AED. The AED will instruct everyone to stand clear. As the operator you should repeat this command and ensure everyone is clear of the patient.

Safety

Oxygen is being used, it should be at least 1 metre away from the AED and consideration should be given to the possibility of Oxygen building up in the atmosphere.

The chest pads should be applied to bare skin. Excessive chest hair can disrupt the contact of the pads with the skin and result in burns when the electrical shock is applied.

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If Carl Shapiro would have had return of spontaneous circulation (ROSC), what would your next interventions be?

Assess and stabilize airway

Implement post- resuscitation protocol

  • vital signs
  • 12-lead ECG neurological exam
  • hypothermia protocol
  • consider CCS transfer

Next Steps

7

What key elements would you include in the handoff report for this patient?

Consider the

SBAR format

situation

background assessment recommendation

If Carl Shapiro’s family members had been present at the bedside during the arrest, describe what you could have done to support them during this crisis.

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What would you do differently if you were to repeat this scenario?

How would your patient care change?

What could have been the causes of Carl Shapiro’s ventricular fibrillation?

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Coronary arteries

Recognition of 12 Lead ECG Changes

12 lead EKG and ST segment

12 Lead ECG Comparisons

12 Lead ECG Comparison

2

When performing CPR for Carl Shapiro, what are quality indicators you are performing resuscitation correctly?

High-quality CPR at 1 ½-2-inch depth-this is done to increase mean arterial pressure improving organ perfusion

Indicators

Where do you check for pulse?

Chest compressions at a rate of 100-120/minutes

Remember 2 minute rotation rule

In advance settings, ETCO2 will return to normal with ROSC

Reflect on Action

Using the Think in action tool

Divide into groups of 3 and review your pre-brief tool and move to the next page.

your patient preparation sheet or reviewing your vsim log (It may help you by group findings and thoughts by admission, event, follow-up)

1. Complete first four columns: (Recognize Cues, Analysis, Priotize Hypothesis)

2. Create three interventions you may anticipate to perform

3. List the tasks that the orders direct you to complete as you care for the patient.

4. Now prioritize both lists

5. As a group we eill share and dicuss your findings

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Post work

YOU DID IT!!!! YOU COMPLETED vSIM #1!!!!

All assigned tasks must be fully competed within 72 hours after your clinical. Late work will not be accepted without prior arrangements made.

Check list

Assure these 3 scores are in your Laerdal course:

1. Pre-Simulation Quiz

2. 80% or higher for simulation execution

3. 80% or higher on the post quiz

Submit your completed post work to Blackboard:

-Student evaluation of virtual simulation learning event

-Simulation Reflection-On-Action

Note: Documents should only have your name on it. Post work is not a group project. Including your name means you are signing off that the work is yours, valid and complete.

Nursing Care Plan

Student Evaluations

Do you have everything done?

All assigned tasks must be fully competed within 72 hours after your clinical. Late work will not be accepted without prior arrangements made.

Check list

Earn an 80% or higher in simulation scenario

Submit your completed work to Blackboard:

-Include completed guided reflection and documentation documents.

-Documents should only have your name on it. This means you are signing off that the work is valid and complete.

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