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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Find/create scenario template Use consistently May vary according to type of sim Examples (Must join – FREE): – Laerdal (2010) ists__worksheets/entry2459.aspx – NLN(2010); Childs, Sepple & Chambers, Copyright M. Anderson 2012

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

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

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

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

Dog or zebra? Copyright M. Anderson 2012

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

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

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

“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

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

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

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

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

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

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

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

Let’s try another scenario Copyright M. Anderson 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See provided reference list Copyright M. Anderson 2012