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If I only knew then what I know now… Presented by: Cynthia G. Cunningham, MSN, RN Southwestern Virginias Regional Clinical Simulation Centers.

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Presentation on theme: "If I only knew then what I know now… Presented by: Cynthia G. Cunningham, MSN, RN Southwestern Virginias Regional Clinical Simulation Centers."— Presentation transcript:

1 If I only knew then what I know now… Presented by: Cynthia G. Cunningham, MSN, RN Southwestern Virginias Regional Clinical Simulation Centers

2 State Council of Higher Education in Virginia (SCHEV) and regional nursing programs met to explore ways of partnering with public and private entities to: Maximize the use of scarce resources Address the shortage of nursing faculty Explore alternatives for nursing student clinical education June 8, 2005

3 Radford University Jefferson College of Health Sciences Wytheville Community College New River Community College Virginia Western Community College Patrick Henry Community College THE PARTNERSHIP Collaboration of nursing educators to develop strategies to address the shortage

4 Developed the CSC concept Submitting CSC proposal to SCHEV Proposal was included in the Governors Budget for the next biennium Funding for the project was allocated to Radford University in July 2006 RU SON ASSUMED LEADERSHIP

5 To alleviate the shortage of nurses in Virginia by increasing the capacity of nursing schools to enroll students, maximizing use of faculty resources, and decreasing competition for scarce clinical sites OVERALL GOAL OF THE CSC

6 The Clinical Simulation Centers will provide a hands-on learning experience in an environment that is safe and realistic, producing quality nurses with enhanced critical thinking abilities, communication skills and collaboration experience VISION

7 THE BUSINESS PLAN History Profile Business Summary Product/Services Industry Analysis Marketing Analysis Organization/Management Financial Section Assumptions Revenue Streams CSC Budgetary Projections Personnel Operating Equipment Lists

8 The renovation SIMmares Definition: Simulation based disturbing dreams. Typically occurring between 3am - 5am. Occasionally may happen during the day.

9 Renovation/Space Planning Team CSC Director Facilities Planning and Construction Create-a-lab Rep Laerdal Sales Rep Education Management Solutions (EMS) Hardware Design Specialist

10 My renovation team is gone and I dont know what I am doing…. SIMmare #1

11 Laerdal rep decided to change territories Wanted to move back to Texas ………… Education Management Solutions (EMS) rep decided traveling was not conducive to a personnel life! Was married within a year Create-a-lab rep decided to start a family Had a bouncing baby boy Renovation team turn over…... Do you think it could be me?!!!!

12 I would have an exit review with any renovation team member leaving the project. I would visit more SimCenters and ask more questions r/t design I would participate in more SUNs If I knew then what I know now

13 And if necessary ………….

14 Great for entertaining …..boating………relaxing... I live on the Lake and have a boat and SeaDoo…

15 ……..and they are great with children I have two Newfoundlands

16 I ASSuMEd and my new team members ASSuMEd Due renovation team turn-over

17 The control room SIMmare #2 CONNECTIVITY

18 I would have clear operational expectations – central control room separate from SIMroom with A/V observation I would include IT in the renovation team I would include – SimPhones to connect each SimRoom to each control room operating station If I knew then what I know now

19 My SIMteam RU SON CSC Director (MSN) RHEC Site RU West Site VWCCPHCCJCHSRU WCC NRCCRU 2 MSNs, 1 IT Specialist 1 Admin Specialist II 2 MSNs, 1 IT Specialist 1 Admin Specialist II

20 Receiving and Installing 1.9 Million Dollars of Equipment SIMmare #4 Of course spending was not the nightmare…. Receiving, installing and tagging all items > $5000 and all IT equipment was!

21 Include on- site delivery & installation in purchasing agreement Receiving Equipment - Laerdal Humm This doesn't look good

22 – manikins, room furnishings, task trainers, virtual IV…… Laerdal representative after receiving equipment Purchasing Agreement Sturgis DREAMS: Russell returns to Virginia

23 Installing Equipment Room set-ups per site: 1 Med/Surg SimRoom 1 ICU SimRoom 1OB SimRoom 1 Pediatric SimRoom 2 Exam Rooms 1 Multipurpose classroom with 3-5 patient beds Simulation Apartment Computer Classroom Manikin Assembly: 4 SimMan 4 SimBaby 2 Nursing & 2 ALS Annes 2 MegaCode & 2 Nursing Kellys 2 Nursing & 2 MegaCode Kids 2 Nursing Baby 2 Noelle 4 Adult & 2 Peds Virtual IV, …….

24 Installing Equipment - Laerdal Ouch! SimMan kicked me! SimMan, try to behave yourself

25 Laerdal representative after installation of equipment Sturgis DREAMING: My new territory …TEXAS!

26 Installing A/V & IT equipment Room set-up x 7 per site: 2 Pan Tilt Zoom Cameras Microphone Cabling between room and control room to connect ( cat 5, extender boxes ) Cabling between room and server room (A/V connections) Cabling between control room and server room Server Room: 2 DVRs 2 computers to control DVR 1 computer to manage video 1 SQL server (database) 1 IIS server (web) 1 Quantum Tape Library 1 SNAP Server for video storage

27 Installing A/V & IT equipment

28 I would hire 1 IT specialist and 5 MSNs: Rationale for one IT specialist: A bored IT leads to a gone IT Most everything can be fixed remotely Standardization between sites Rationale for Additional MSN: Increased capacity of students served (450 students/semester) Increased volume of scenarios produced Back-up for staffing due to illness/surgery, time off…. If I knew then what I know now

29 Manikin responses are not in sync with monitor readings or scenario program SIMmare #5 Another CONNECTIVITY Problem

30 Nine Pin Problem PROBLEM: Cable extender box – nine pin connection – transmission delays between control room and manikin. Manikin pulses and heart rate did not correlate with programmed settings and monitor waveforms (EKG, Pulse…) SOLUTION: Pull nine-pin cable through wall/ceiling and directly connect to laptop, i.e., by passing the rose boxes.

31 I would request that integrating equipment be tested with the manikin system prior to purchase or include a contingency plan for beta testing in the purchasing agreement If I knew then what I know now

32 CONTROL ROOM Imagine: No Monitors Imagine: No plan to connect manikin to the Laptop






38 Lessons Learned Over TIME Student driven Organization Admission ticket Incorporate pre/post encounter evaluation and add NCLEX ? to pre Reinforce concepts/nursing process included in admission ticket, pre- encounter, and scenario Incorporate NCLEX ?s Start early… Partner and/or barter with as many organizations as possible Charge fee for unused time Block scheduling Scenario DevelopmentRevenue Planning Student Preparation & Evaluation Organized Debriefing Partnering/Bartering Scheduling

39 Curriculum Integration Orientation Boot-camps Fundamental Front-loading Standardized patient encounters Mental health Assessment, H&P Follow course syllabus when choosing scenario

40 Consider fidelity Choose the right manikin/SP for the simulation If equipment is needed actually use the equipment – headwall O2/suctioning, IV pump, 12-lead…. Include supporting documentation – SIMChart Suspend disbelief – do not ask students to pretend or use phrases like if you were taking care of a real patient….you would…..

41 Student Driven NOT Operator Driven Student intervention or non-intervention dictates manikin action All vocals are pre-recorded Use handlers for all actions that are not tied to time or sequencing If sequencing is important, incorporate standardized cues (vocal, manikin action)

42 Lessons Learned SCENARIO DEVELOPMENT & REVIEW & STORAGE Scenario Development Process Standardized event menus Indicate events with v. if vocal is attached Lab reports, xrays,…as pdf files to display on pt. monitor Scenarios reviewed & revised every summer to insure best practice


44 Lessons Learned Shared scenario storage system FinalSim houses all up-dated scenarios - batch file runs every night to load to Laerdal computers SCENARIO DEVELOPMENT & REVIEW & STORAGE Scenario Storage








52 Lessons Learned Need better criteria to assess preparedness. Too much information in post encounter evaluation Information is fragmented – inconsistent flow from prep work through post encounter evaluation. All scenarios have an admission ticket – student must complete the admission ticket to participate in the simulation Incorporate a pre-encounter and post- encounter student questionnaires Incorporate nursing process in pre/post encounter evaluation Incorporate NCLEX question in pre- encounter and into debriefing Assessing PreparednessSolutions to Assessing Preparedness Data Collection The bigger picture Solutions to Data Collection Solution to making a bigger impact Preparation-Evaluation-Debriefing Putting it all Together



55 Lessons Learned Student driven Incorporate admission ticket questions, pre-encounter into discussion Video review NCLEX question review Debriefing

56 1.A client admitted with a diagnosis of chronic atrial fibrillation is on a daily dose of warfarin (Coumadin) 2.5 mg. The serum international normalized ratio (INR) is 4.7. What intervention should the nurse be prepared to initiate? 1. Observe the client for a possibility of an embolic event. 2. Have a partial prothrombin time (PTT) drawn to completely evaluate the level of anticoagulation. 3. Prepare to administer protamine sulfate. 4. Monitor the client for signs of bleeding.

57 1. A client admitted with a diagnosis of chronic atrial fibrillation is on a daily dose of warfarin (Coumadin) 2.5 mg. The serum international normalized ratio (INR) is 4.7. What intervention should the nurse be prepared to initiate? 1. Incorrect. If the client were at risk for an embolism, the INR would be very low, reflecting inadequate anticoagulation. 2. Incorrect. PTT evaluates anticoagulation levels as a result of heparin, not warfarin. 3. Incorrect. Protamine sulfate is the antidote for heparin, not warfarin. 4. Correct. The level of anticoagulation, as reflected by the INR, is too high and the client is at risk for bleeding. The serum INR is done to reflect the effectiveness of oral anticoagulants, especially warfarin. The normal value is 2.0-3.0 for clients on anticoagulation therapy. Test-Taking Tip: Because the drug is a anticoagulant, choose the assessment type of answer for the one most related to anticoagulant therapy. Eliminate answers 2 and 3 since r/t heparin.

58 Lessons Learned Nursing Process Driven Medication error reporting Curriculum integration questions RAGE Evaluation




62 Any questions?

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