1. Improving Care for Pediatric Patients Mindi Anderson, PhD, RN, CPNP-PC, CNE, ANEF Copyright© M. Anderson 2012

2. Current research funding: – Laerdal Foundation for Acute Medicine, National League for Nursing (NLN), UT Arlington, HRSA Previous/current consultant: – NLN/Laerdal Teach CE course/sim courses Smart Hospital™ Copyright M. Anderson 2012

3. 1. Discuss the medical/legal environment in the pediatrics area. 2. Identify issues specific to pediatrics care. 3. Discuss the history of pediatric simulation. 4. Describe the role of simulation in providing quality (adequate) pediatric education. Copyright M. Anderson 2012

4. 5. Discuss collaboration with multidisciplinary leadership. 6. Describe how to plan and implement pediatric simulations. 7. Define measurable objectives for success. Copyright M. Anderson 2012

5. Can not use actual patients for skills = safety Policies and procedures = students (Nishisaki et al., 2012) Copyright M. Anderson 2012

6. Adolescents (case example) – Inconsistent laws – Considerations Confidentiality Consent by minors Emancipated minor (Hicks & Rome, 2011) Copyright M. Anderson 2012

7. Providers need training Survey of physicians (n = 88) found ethics (pediatrics) problems related to: – Relationships – End-of-life – Conduct of professionals – Economics/policies – Educational process (Guedert & Grosseman, 2012) Copyright M. Anderson 2012

8. Decreased clinical sites; decreased procedures Decreased unit time Worsening morbidity/mortality Higher acuity; but students may not get to care for Low-volume but high-risk (Birkhoff & Donner, 2010; Bultas, 2011; Schneider Sarver, Senczakowicz, & Murphy Slovensky, 2010) Copyright M. Anderson 2012

9. Decreased skills Seasonality Shift = outpatient care Graduate = site issues, decreased preceptors Missing curricular pieces (Cook, 2012; Schneider Sarver et al., 2010) Copyright M. Anderson 2012

10. Assessment- – Need for competency validation – Skills/performance (eg. anesthesia) “Children are not little adults” (McQueen, Mitchell, & Joseph-Griffin, 2011, p. 780) Anatomy changes with age; need to know appropriate equipment (Birkhoff & Donner, 2010; Fehr et al., 2011; McQueen et al., 2011) Copyright M. Anderson 2012

11. Balancing patient/family needs Increased emotions = end-of-life – Often not covered – Lecture does not teach feeling – Are students prepared? (Cheng, Donoghue, Gilfoyle, & Eppich, 2012; Lindsay, 2010) Copyright M. Anderson 2012

12. Study = “Standardized” mothers, gave history via telephone to interns/residents (Brown & Eberle, 1974) First pediatric simulator – 90’s (Rosen, 2008) “Pediatric clinical skills assessment” – SPs (Lane, Ziv, & Boulet, 1999, p. 640) Copyright M. Anderson 2012

13. Virtual = clinics in Second Life® (SL) (Cook, 2012) Copyright M. Anderson 2012

14. Skills – Communication – Medication dosage/administration – Assessment – Procedures – Charting Clinical judgment (Bultas, 2011; McQueen et al., 2011) Copyright M. Anderson 2012

15. Orientation – students/new hires Meet important objectives/outcomes Competency/performance – Eg. Clinical check-offs – OSCEs Preparation = Continuing Education (ICU areas) (Broussard, Myers, & Lemoine, 2009; Bultas, 2011; Cazzell & Rodriguez, 2011) Copyright M. Anderson 2012

16. A way to teach EBP Incorporate core concepts (Aebersold, 2011; Waxman, 2010) Copyright M. Anderson 2012

17. Need for coordinated teams Activities are often team-based (airway) Want students to learn roles prior to graduation (Birkhoff & Donner, 2010; Nishisaki et al., 2012) Copyright M. Anderson 2012

18. Interprofessional education: “When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010) (Interprofessional Education Collaborative Expert Panel, 2011, p.2) Copyright M. Anderson 2012

19. Interprofessional Education Collaborative Expert Panel (2011) 4 categories competencies: – Values/ethics – Roles/responsibilities – Communication – Working as a team Copyright M. Anderson 2012

20. Bring disciplines to the table Leaders/stakeholders from each Who can you collaborate with? Copyright M. Anderson 2012

21. Medicine Nursing Social Work Chaplains Radiology Respiratory Therapy Pharmacy OT/PT Phlebotomy Copyright M. Anderson 2012

22. Who else? Think about hurdles prior Copyright M. Anderson 2012

23. Death/dying = child (Youngblood, Zinkan, Tofil, & White, 2012) – Purpose = Communication – Mannequins/actors – Participants: Fellows Nurses Social workers Chaplain Copyright M. Anderson 2012

24. One study (n = 105) = increased collaboration between physician- nurse with each scenario (Messmer, 2008) Copyright M. Anderson 2012

25. Interview/survey stakeholders Look at trends/region/season/ M&M/competencies Inpatient (survey) – Codes – Managing an airway/airway issues (Deutsch, Olivieri, Hossain, & Sobolewski, 2010; Interprofessional Education Collaborative Expert Panel, 2011) Copyright M. Anderson 2012

26. What are your shared goals/content/competencies? Copyright M. Anderson 2012

27. Use pre-written versus write your own? Pre-written: – Ex. http://www.mysimcenter.co m/en- US/SimStoreHome.aspx http://www.mysimcenter.co m/en- US/SimStoreHome.aspx Pre-written = may need to tweak (Durham & Alden, 2008 ) Copyright M. Anderson 2012

28. Find/create scenario template Use consistently May vary according to type of sim Examples (Must join – FREE): – Laerdal (2010) http://simulation.laerdal.com/forum/files/folders/checkl ists__worksheets/entry2459.aspx – NLN(2010); Childs, Sepple & Chambers, 2007 http://sirc.nln.org Copyright M. Anderson 2012

29. Target group/population – Multiple? Year/experience Formulate: – Overall goal – Specific objectives (1 ◦, 2 ◦ ) – Based on topic (Anderson & LeFlore, 2008 ; Childs et al., 2007; Durham & Alden, 2008; Hwang & Bencken, 2008; Laerdal, 2010; Smith, 2009; Stillsmoking, 2008; Waxman, 2010) Copyright M. Anderson 2012

30. Purpose Ex. – Skills Learning Practicing – Competency – Team training/teamwork Every scenario vs. specific focus (Cheng et al., 2012; Stillsmoking, 2008)

31. Do not “throw them the kitchen sink” “Save the world” Start with a code Copyright M. Anderson 2012

32. Maintain reality Do not “trick” participants (Cheng et al., 2012) Copyright M. Anderson 2012

33. Dog or zebra? Copyright M. Anderson 2012

34. Focus – Ex. Simple versus complex Procedures vs. critical thinking (putting it all together) (Anderson & LeFlore, 2008) Copyright M. Anderson 2012

35. 1.Observing 2.Diagnosing 3.Treating/Intervening 4.Interacting 5.Practicing- pass/competent (Murray, 2004)

36. Pre-program vs. “on-the-fly” (Childs et al., 2007) Copyright M. Anderson 2012

37. “Statement of cognitive (knowledge), affective (attitude), and/or psychomotor (skills) goal(s)” (The International Nursing Association for Clinical Simulation and Learning [INACSL] Board of Directors, 2011a, p. S4) Copyright M. Anderson 2012

38. Objectives = guide scenario/outcome Remember: – Should be able to meet – Reflect different domains – Correlate to course/program outcomes – Be based on evidence (Alinier, 2011; The INACSL Board of Directors, 2011b; Jeffries & Rogers, 2007; Smith, 2009; Waxman, 2010) Copyright M. Anderson 2012

39. This is the most important step! (Waxman, 2010) Copyright M. Anderson 2012

40. Number – 1-6 (depends) Formulate prior Check with stakeholders Make measureable, clear! Utilize your resources Provide to participants? (Alinier, 2010; Anderson & LeFlore, 2008; Jeffries & Rogers, 2007; Smith, 2009; Stillsmoking, 2008; Waxman, 2010) Copyright M. Anderson 2012

41. Use appropriate verb (action) Bloom’s (higher levels?) - cognitive (Overbaugh & Schultz, n.d.) Copyright M. Anderson 2012

42. As you are writing objectives, how will you evaluate? Remember critical behaviors (Anderson & LeFlore, 2008; Smith, 2000; Waxman, 2010) Copyright M. Anderson 2012

43. Let’s take a look at the following situation Copyright M. Anderson 2012

44. Pick type = match objectives Fidelity Let’s go back to our situation (Anderson & LeFlore, 2008; Jeffries & Rogers, 2007; Smith, 2009; Stillsmoking, 2008; Waxman, 2010) Copyright M. Anderson 2012

45. Let’s try another scenario Copyright M. Anderson 2012

47. Name, concepts, demographics Patient- Newborn/preemie, infant, child, or adolescent? Diagnosis/es and differentials = reinforce objectives Describe; summarize What will you report? (Alinier, 2011; Anderson & LeFlore, 2008; Aebersold, 2011; Childs et al., 2007; Hwang & Bencken, 2008; Laerdal, 2010) Copyright M. Anderson 2012

48. What skills/knowledge do participants need to come with? (Anderson & LeFlore, 2008; Childs et al., 2007; Laerdal, 2010) Copyright M. Anderson 2012

49. Follow your template Describe environment – where is your patient? – Unit? – PICU? – Healthcare provider’s office? – Home? (Anderson & LeFlore, 2008; Childs et al., 2007; Durham & Alden, 2008; Laerdal, 2010; Stillsmoking, 2008) Copyright M. Anderson 2012

50. What will he/she look like at the beginning? Monitor should match (Laerdal, 2010; Stillsmoking, 2008) Copyright M. Anderson 2012

51. List events that will happen – how will scenario progress? Flowchart Think about cues/prompts (Alinier, 2011; Childs et al., 2007; Laerdal, 2010; Waxman, 2010) Copyright M. Anderson 2012

52. Equipment Moulage/supplies/props (Alinier, 2011; Childs et al., 2007; Laerdal, 2010) Copyright M. Anderson 2012

53. Length? Number of participants/scenario (grouping) Roles Actors/confederates (Alinier, 2011; Anderson & LeFlore, 2008; Childs et al., 2007; Durham & Alden, 2008; Hwang & Bencken, 2008; Waxman, 2010) Copyright M. Anderson 2012

54. Debriefing questions – Remember objectives Use/keep references (Alinier, 2011; Anderson & LeFlore, 2008; Childs et al., 2007; Durham & Alden, 2008; Jeffries & Rogers, 2007; Laerdal, 2010; Smith, 2009; Waxman, 2010) Copyright M. Anderson 2012

55. How/when will it end? (Alinier, 2011; Murray, 2004; Stillsmoking, 2008) Copyright M. Anderson 2012

56. Suggestions scenario more complex Example: culture (Spanish- speaking only), co- morbidity (preemie) (Childs et al., 2007)

57. Think about pre-assignments – Increases effectiveness of simulation time Directions for participants Make sure you have enough help Videotape? (Bultas, 2011; Durham & Alden, 2008; Waxman, 2010) Copyright M. Anderson 2012

58. Set-up Practice! Orient – Roles – Scenario objectives – Type of simulation/simulator – Simulated environment (Alinier, 2011; Childs et al., 2007; Durham & Alden, 2008 ; Horn & Carter, 2007, Smith, 2009) Copyright M. Anderson 2012

59. P’s for Success – Passion – Plan (Personnel, Participants, Props) – Prep (Patient, Participants) – Practice – Proceed – Process (Debrief) (Alinier, 2011; Horn & Carter, 2007) Copyright M. Anderson 2012

60. Helps with resources Ex. – Canadian Pediatric Simulation Network – EXPRESS - research (Cheng et al., 2011; Grant & Cheng, 2010) Copyright M. Anderson 2012

61. Whether simulation improves outcomes with patients (Birkhoff & Donner, 2010) Copyright M. Anderson 2012

62. See provided reference list Copyright M. Anderson 2012